Full Text Available Health care organizations have to develop a sustainable path for creating public value by seeking legitimacy for building and maintaining public trust with patients as social and economic institutions creating value and sustaining both health and wealth for people and communities within society. Health care organizations having at disposal decreasing resources and meeting increasing demands of citizens are following an unsustainable path. Designing sustainable health care systems and organizations is emerging as a strategic goal for developing the wealth of people and communities over time. Building sustainable organizations relies on valuing human resources, designing efficient and effective processes, using technology for better managing the relationships within and outside organizations. Sustainable health care organizations tend to rediscover the importance of human resource management and policies for effectively improving communication with patients and building trust-based relationships. While processes of accreditation contribute to legitimizing effectiveness and quality of health care services and efficient processes, introducing and using new information and communication technologies (ICTs and informatics helps communication leading to restore trust-based relationships between health care institutions and patients for value creation within society.
On the occasion of Development Week in Canada, Dr. Remi Sogunro spoke in February, 1994, about the many achievements of quality primary health care and PLAN's strategy to achieve sustainability. In one generation, under-5 mortality has been cut by a third. Deaths from measles has been reduced from 2.5 million to 1 million a year. Skeletal deformities from polio also have been reduced from 1/2 million to less than 140,000. Despite all this, there is much more to be attained. 35,000 children under 5 die from preventable diseases every day in developing countries. The health community is working hard to address these silent emergencies. PLAN International's primary health care program targets the poor and undeserved populations where diseases are prevalent. The main focus of PLAN's programs are mothers and children who are most vulnerable to disease. Key interventions that PLAN gives priority to are childhood and maternal immunization programs, including pre- and post-natal care for mothers. Other interventions under PLAN's comprehensive primary health care program include: control of diarrheal diseases and acute respiratory infections, growth monitoring, nutrition and control of STDs and HIV/AIDS infection, water and sanitation, family planning information and educational services, and rehabilitation of the handicapped. "Go in search of people, begin with what they know, build on what they have," goes a Chinese proverb. This also summarizes PLAN's guiding principle for achieving sustainable development: the importance of investing in people. PLAN's programs in the field build partnerships and empower communities. PLAN's emphasis on institution-building and capacity-building with local institutions is an important part of organizational strategy to ensure sustained development. full text
Liaropoulos, Lycourgos; Goranitis, Ilias
The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to “traditional” issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a glo...
Geoffrey A. Cordell
Full Text Available Each day, Earth's finite resources are being depleted for energy, for material goods, for transportation, for housing, and for drugs. As we evolve scientifically and technologically, and as the population of the world rapidly approaches 7 billion and beyond, among the many issues with which we are faced is the continued availability of drugs for future global health care. Medicinal agents are primarily derived from two sources, synthetic and natural, or in some cases, as semi-synthetic compounds, a mixture of the two. For the developed world, efforts have been initiated to make drug production "greener", with milder reagents, shorter reaction times, and more efficient processing, thereby using less energy, and reactions which are more atom efficient, and generate fewer by-products. However, most of the world's population uses plants, in either crude or extract form, for their primary health care. There is relatively little discussion as yet, about the long term effects of the current, non-sustainable harvesting methods for medicinal plants from the wild, which are depleting these critical resources without concurrent initiatives to commercialize their cultivation. To meet future public health care needs, a paradigm shift is required in order to adopt new approaches using contemporary technology which will result in drugs being regarded as a sustainable commodity, irrespective of their source. In this presentation, several approaches to enhancing and sustaining the availability of drugs, both synthetic and natural, will be discussed, including the use of vegetables as chemical reagents, and the deployment of integrated strategies involving information systems, biotechnology, nanotechnology, and detection techniques for the development of medicinal plants with enhanced levels of bioactive agents.
Liaropoulos, Lycourgos; Goranitis, Ilias
The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.
Ramirez, Bernardo; West, Daniel J; Costell, Michael M
This paper aims to examine the concept of sustainability in health care organizations and the key managerial competencies and change management strategies needed to implant a culture of sustainability. Competencies and management development strategies needed to engrain this corporate culture of sustainability are analyzed in this document. This paper draws on the experience of the authors as health care executives and educators developing managerial competencies with interdisciplinary and international groups of executives in the last 25 years, using direct observation, interviews, discussions and bibliographic evidence. With a holistic framework for sustainability, health care managers can implement strategies for multidisciplinary teams to respond to the constant change, fine-tune operations and successfully manage quality of care. Managers can mentor students and provide in-service learning experiences that integrate knowledge, skills, and abilities. Further empirical research needs to be conducted on these interrelated innovative topics. Health care organizations around the world are under stakeholders' pressure to provide high quality, cost-effective, accessible and sustainable services. Professional organizations and health care providers can collaborate with university graduate health management education programs to prepare competent managers in all the dimensions of sustainability. The newly designated accountable care organizations represent an opportunity for managers to address the need for sustainability. Sustainability of health care organizations with the holistic approach discussed in this paper is an innovative and practical approach to quality improvement that merits further development.
C.H.M. Smits (Carolien); A. Harps (Annelies); A.M.V. Stoopendaal (Annemiek); A.M. Kamper (Ad); M.M.H. Strating (Mathilde); R.A. Bal (Roland)
markdownabstractBackground: The Care for Better Region program was developed to achieve sustainable care improvement focusing onfall prevention. Key ingredients involved improvement teams developing and implementing a falls reduction plan, PracticeDevelopment; facilitation of
Sibthorpe, Beverly M; Glasgow, Nicholas J; Wells, Robert W
A synthesis of the findings of the five studies of sustainability of primary health care innovation across six domains (political, institutional, financial, economic, client and workforce) yielded three main themes. These were: the importance of social relationships, networks and champions; the effect of political, financial and societal forces; and the motivation and capacity of agents within the system. The need for routine assessment of the sustainability of primary health care innovations is discussed. Given the dearth of literature on the sustainability of primary health care innovation, there is potential to develop a program of research directed towards a future synthesis of evidence.
Urbanos-Garrido, Rosa María; López-Valcárcel, Beatriz G
The purpose of this paper is to describe the main proposals for ensuring national health service sustainability, in the light of a review of the most relevant diagnostic reports and guidelines published since the onset of the economic crisis. The following proposals are among the most frequently mentioned in the literature: selective financing of technology, reorganization to provide more care for chronic conditions and better coordination between levels of care and the network of social and health care services, and the reinforcement of primary care. Also commonly suggested is the reform of health care governance. Likewise, the authors briefly examine the measures adopted to date to promote the system's sustainability and discuss how the emergency department can further this aim.
Full Text Available In order to be the health care system sustainable , management transformations must be based on very precise diagnostic analysis that includes complete and current information. It is necessary to implement an information system that collects information in real time, that watches the parameters that significantly influence the sustainability of the system. Such an information system should point out a radiography(a scan of the system at some time under following aspects:: 1. An overview of system; 2 An overview of the economic situation; 3 A technical presentation ;4. A legal overview; 5. A social overview ; 6. A management overview .Based on these Xrays of the health system, it outlines a series of conclusions and recommendations together with a SWOT analysis that highlights the potential internal (strengths and weaknesses and external potential (opportunities and threats. Based on this analysis and recommendations, the management is going to redesign the system in order to be adapted to the changing environmental requirements. Management transformation is recommended to be by following steps. :1. The development of a new management system that would make a positive change in the health care system 2. Implementation of the new management system 3. Assessment of the changes
Richardson, Janet; Grose, Jane; O'Connor, Anita; Bradbury, Martyn; Kelsey, Janet; Doman, Maggie
Aim To evaluate attitudes towards embedding sustainability and climate change in nursing curricula among nursing students, some of whom had participated in a sustainability and health skills session, and determine whether the session could improve knowledge of sustainability. Methods Three months after the sustainability session, students who had participated along with a sample of students who had not, completed a Sustainability Attitudes in Nursing Survey questionnaire. This investigated attitudes towards climate change and sustainability in nursing curricula and the costs of clinical and domestic waste disposal. Results Nursing students were positive about sustainability and climate change and its inclusion in the curriculum, irrespective of their participation in the sustainability scenario session. Participants in the sustainability session were more likely to identify correctly the cost of clinical waste disposal in the NHS. Conclusion The sustainability and health skills session has the potential to improve nursing students' knowledge of the cost of clinical waste disposal.
Birch, Stephen; Murphy, Gail Tomblin; MacKenzie, Adrian; Cumming, Jackie
The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Kaplan, Susan B; Forst, Linda
Limited but growing evidence demonstrates that environmental sustainability in the health-care sector can improve worker and patient health and safety. Yet these connections are not appreciated or understood by decision makers in health-care organizations or oversight agencies. Several studies demonstrate improvements in quality of care, staff satisfaction, and work productivity related to environmental improvements in the health-care sector. A pilot study conducted by the authors found that already-collected data could be used to evaluate impacts of environmental sustainability initiatives on worker and patient health and safety, yet few hospitals do so. Future research should include a policy analysis of laws that could drive efforts to integrate these areas, elucidation of organizational models that promote sharing of environmental and health and safety data, and development of tools and methods to enable systematic linkage and evaluation of these data to expand the evidence base and improve the hospital environment.
Ford, James H; Krahn, Dean; Oliver, Karen Anderson; Kirchner, JoAnn
To explore staff perceptions about sustainability, commitment to change, participation in change process, and information received about the change project within the Veterans Administration Primary Care and Mental Health Integration (PC-MHI) initiative and to examine differences from the Veterans Health Administration Mental Health Systems Redesign (MHSR) initiative. Surveys of change team members involved in the Veterans Affairs PC-MHI and MHSR initiatives. One-way analysis of variance examined the relationship between commitment, participation and information, and sustainability. Differences in PC-MHI sustainability were explored by location and job classification. Staff sustainability perceptions were compared with MHSR results. Sustainability differed by staff discipline. Difference between MHSR and PC-MHI existed by job function and perceptions about the change benefits. Participation in the change process and information received about the change process were positively correlated with sustainability. Staff commitment to change was positively associated with staff perceptions about the benefits of change and staff attitudes toward change. Sustainability is an important part of organizational change efforts. Change complexity seems to influence perception about sustainability and impacts staff perceptions about the benefits of change. These perceptions seem to be driven by the information received and opportunities to participate in the change process. Further research is needed to understand how information and participation influence sustainability and affect employee commitment to change.
Shelton, Rachel C; Cooper, Brittany Rhoades; Stirman, Shannon Wiltsey
There is strong interest in implementation science to address the gap between research and practice in public health. Research on the sustainability of evidence-based interventions has been growing rapidly. Sustainability has been defined as the continued use of program components at sufficient intensity for the sustained achievement of desirable program goals and population outcomes. This understudied area has been identified as one of the most significant translational research problems. Adding to this challenge is uncertainty regarding the extent to which intervention adaptation and evolution are necessary to address the needs of populations that differ from those in which interventions were originally tested or implemented. This review critically examines and discusses conceptual and methodological issues in studying sustainability, summarizes the multilevel factors that have been found to influence the sustainability of interventions in a range of public health and health care settings, and highlights key areas for future research. Expected final online publication date for the Annual Review of Public Health Volume 39 is April 1, 2018. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
Cruz, J P; Alshammari, F; Felicilda-Reynaldo, R F D
This study aimed to investigate the predictors of Saudi nursing students' attitudes towards the environment and sustainability in health care. With rising temperature and decreasing annual rainfall, Saudi Arabia is threatened by the harmful effects of climate change on its population. In response to these threats, the Ministry of Health adapted sustainable development and environmental preservation in their National E-Health strategy. To implement these policies successfully, healthcare practitioners should be educated on how climate change could impact human health negatively. A secondary analysis of 280 questionnaires from baccalaureate nursing students of a university in Hail City, Saudi Arabia, was completed. The New Ecological Paradigm (NEP) Scale and Sustainability Attitudes in Nursing Survey 2 (SANS-2) were used to investigate the predictors of student attitudes towards the environment and sustainable development in health care. The NEP score indicated moderate pro-environment attitudes, whereas the SANS-2 mean score showed very positive attitudes towards sustainability in health care. Learning about the environment and related issues in the nursing programme, raising climate change awareness and attending environment-related seminars and training positively influenced the environmental and sustainability attitudes of nursing students. Saudi nursing students moderately manifested pro-environment attitudes but exhibited extremely positive attitudes towards sustainability in health care. The results support the need to strengthen the education of nursing students about environmental and sustainability concepts and the inclusion of these topics in the nursing curricula. The study underscores the critical role of enriching the awareness of nursing students on environmental issues and concerns and sustainability in health care. The findings of this study can support the inclusion of course contents, which deal specifically with environmental health and
Stolldorf, Deonni P
Rapid response team (RRT) adoption and implementation are associated with improved quality of care of patients who experience an unanticipated medical emergency. The sustainability of RRTs is vital to achieve long-term benefits of these teams for patients, staff, and hospitals. Factors required to achieve RRT sustainability remain unclear. This study examined the relationship between sustainability elements and RRT sustainability in hospitals that have previously implemented RRTs.
Persaud, D David
The development of sustainable health care organizations that provide high-quality accessible care is a topic of intense interest. This article provides a practical performance management framework that can be utilized to develop sustainable health care organizations. It is a cyclical 5-step process that is premised on accountability, performance management, and learning practices that are the foundation for a continuous process of measurement, disconfirmation, contextualization, implementation, and routinization This results in the enhancement of learning, innovation, adaptation, and sustainability (ELIAS). Important considerations such as recognizing that health care organizations are complex adaptive systems and the presence of a dynamic learning culture are necessary contextual factors that maximize the effectiveness of the proposed framework. Importantly, the ELIAS framework utilizes data that are already being collected by health care organizations for accountability, improvement, evaluation, and strategic purposes. Therefore, the benefit of the framework, when used as outlined, would be to enhance the chances of health care organizations achieving the goals of ongoing adaptation and sustainability, by design, rather than by chance.
Clinical commissioning is a current health care management model for primary, secondary, and long term health care needs n United Kingdom nowadays. Form on 1 April 2013, Primary care trusts (PCTs) and strategic health authorities (SHAs) have been abolished. Clinical Commissioning Groups (CCGs) work with local authorities to address the wider determinants of health that is used to help people make positive changes to their lifestyle. NHS England (formerly the NHS Commissioning Board) and CCGs ...
Stroul, Beth A; Manteuffel, Brigitte A
The federal Comprehensive Community Mental Health Services for Children and Their Families Program was initiated in 1992 to provide grants to states, communities, territories, and Indian tribes to develop systems of care to serve children and adolescents with or at risk for emotional disorders and their families. As part of the national evaluation of this program, a study was undertaken to assess the ability of funded sites to sustain their systems of care beyond the federal grant period. The study involved a web survey and telephone interviews with local and state respondents to examine the extent to which key components of systems of care were maintained during the period in which federal funds were phasing out and during the post grant period. Study results demonstrate positive and negative changes that occurred in the communities which are included in the sample, with respect to maintaining the availability of each service included in the broad service array, the implementation of system of care principles, the system of care infrastructure, and the achievement of system of care goals. In addition, results identify factors that contribute to or impede the ability to sustain systems of care, and the effectiveness of various strategies for sustainability. Study findings offer guidance not only to federally funded system of care communities but also to non-funded communities engaged in system of care development to enhance their ability to sustain systems of care for this population over time. Findings will also assist federal, state, and local policymakers, technical assistance providers, family members, advocates, and other key stakeholders to more effectively support the development of viable, sustainable systems of care.
Macpherson, Cheryl C; Hill, Jonathan
Climate change threatens health, health care, and the industries and resources upon which these depend. The growing prevalence and severity of its health consequences and economic costs are alarming health professionals and organizations as their professional obligations, grounded in the core value of health, include protecting against these harms. One means of fulfilling these obligations is to lead or support sustainability initiatives that are built upon current, reliable, accurate, and unbiased evidence and collaboratively tailored to meet specific needs and respond to specific contexts. We consider why and how health professionals and organizations should lead or support such initiatives. © 2017 American Medical Association. All Rights Reserved.
Lennerz, Jochen K; McLaughlin, Heather M; Baron, Jason M; Rasmussen, David; Sumbada Shin, Meini; Berners-Lee, Nancy; Miller Batten, Julie; Swoboda, Kathryn J; Gala, Manish K; Winter, Harland S; Schmahmann, Jeremy D; Sweetser, David A; Boswell, Marianne; Pacula, Maciej; Stenzinger, Albrecht; Le, Long P; Hynes, William; Rehm, Heidi L; Klibanski, Anne; Black-Schaffer, Stephen W; Golden, Jeffrey A; Louis, David N; Weiss, Scott T; Iafrate, A John
Next-generation sequencing has evolved technically and economically into the method of choice for interrogating the genome in cancer and inherited disorders. The introduction of procedural code sets for whole-exome and genome sequencing is a milestone toward financially sustainable clinical implementation; however, achieving reimbursement is currently a major challenge. As part of a prospective quality-improvement initiative to implement the new code sets, we adopted Agile, a development methodology originally devised in software development. We implemented eight functionally distinct modules (request review, cost estimation, preauthorization, accessioning, prebilling, testing, reporting, and reimbursement consultation) and obtained feedback via an anonymous survey. We managed 50 clinical requests (January to June 2015). The fraction of pursued-to-requested cases (n = 15/50; utilization management fraction, 0.3) aimed for a high rate of preauthorizations. In 13 of 15 patients the insurance plan required preauthorization, which we obtained in 70% and ultimately achieved reimbursement in 50%. Interoperability enabled assessment of 12 different combinations of modules that underline the importance of an adaptive workflow and policy tailoring to achieve higher yields of reimbursement. The survey confirmed a positive attitude toward self-organizing teams. We acknowledge the individuals and their interactions and termed the infrastructure: human pipeline. Nontechnical barriers currently are limiting the scope and availability of clinical genomic sequencing. The presented human pipeline is one approach toward long-term financial sustainability of clinical genomics. Copyright © 2016 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.
Engelhardt, H Tristram
A complex interaction of ideological, financial, social, and moral factors makes the financial sustainability of health care systems a challenge across the world. One difficulty is that some of the moral commitments of some health care systems collide with reality. In particular, commitments to equality in access to health care and to fair equality of opportunity undergird an unachievable promise, namely, to provide all with the best of basic health care. In addition, commitments to fair equality of opportunity are in tension with the existence of families, because families are aimed at advantaging their own members in preference to others. Because the social-democratic state is committed to fair equality of opportunity, it offers a web of publicly funded entitlements that make it easier for persons to exit the family and to have children outside of marriage. In the United States, in 2008, 41% of children were born outside of wedlock, whereas, in 1940, the percentage was only 3.8%, and in 1960, 5%, with the further consequence that the social and financial capital generated through families, which aids in supporting health care in families, is diminished. In order to explore the challenge of creating a sustainable health care system that also supports the traditional family, the claims made for fair equality of opportunity in health care are critically reconsidered. This is done by engaging the expository device of John Rawls's original position, but with a thin theory of the good that is substantively different from that of Rawls, one that supports a health care system built around significant copayments, financial counseling, and compulsory savings, with a special focus on enhancing the financial and social capital of the family. This radical recasting of Rawls, which draws inspiration from Singapore, is undertaken as a heuristic to aid in articulating an approach to health care allocation that can lead past the difficulties of social-democratic policy.
Marschollek, Michael; Wolf, Klaus-H; Bott, Oliver-J; Geisler, Mirko; Plischke, Maik; Ludwig, Wolfram; Hornberger, Andreas; Haux, Reinhold
Despite the abundance of past home care projects and the maturity of the technologies used, there is no widespread dissemination as yet. The absence of accepted standards and thus interoperability and the inadequate integration into transinstitutional health information systems (tHIS) are perceived as key factors. Based on the respective literature and previous experiences in home care projects we propose an architectural model for home care as part of a transinstitutional health information system using the HL7 clinical document architecture (CDA) as well as the HL7 Arden Syntax for Medical Logic Systems. In two short case studies we describe the practical realization of the architecture as well as first experiences. Our work can be regarded as a first step towards an interoperable - and in our view sustainable - home care architecture based on a prominent document standard from the health information system domain.
The aim of the present paper was to review the opportunities currently available to health service planners to advance sustainable development in their future-facing roles within health service organisation. Critical challenges and enablers to facilitate health services planners in adopting a pro-environmental lens are discussed. What is known about the topic? Despite its harmful effect on the environment, health has been slower than other industries to embrace the sustainable development agenda. The attitudes and knowledge base of health service planners with regard to environmental sustainability has not been widely studied. For health service planners, embracing pro-environmental considerations in sustainable model of care development is a powerful opportunity to review care paradigms and prepare for the implementation of meaningful, improved health and system efficiency. What does this paper add? This paper advances the case for health service planners to embrace a pro-environmental stance and guides health service leaders in the preparation and implementation of sustainable and improved health and system efficiency. What are the implications for practitioners? Health service planers are in an ideal position to champion the sustainable development agenda as they explore what care is delivered, how care is delivered and where care is delivered. External policy, health service leadership and carbon literacy are advanced as critical contextual factors to facilitate the key role that health service planners can play in building sustainable healthcare organisations.
Full Text Available Active participation and personal responsibility of patients for their own health are necessary to realise the idea of the sustainable development of health care. Aim: To study the readiness of patients to take personal responsibility for their health. Material and Methods:A questionnaire was prepared for the purposes of the study.The methods utilised were a direct individual anonymous questionnaire, statistical – descriptive, analytical (hi – square. The answers were examined and statistically processed according to age, gender and education level of the participants. Results: 1. 92,7 % of those between 18-24 years old answered, that the decision to change their lifestyle in order to prevent disease, depend on the deprivation they have to suffer. 2. Only ¼ are responsible for their health, while the ones who know they have to do it, but they do not are 12,2%. 3. University graduates pay more attention and take more care for their health. 4. Lack of time is the primary reason patients cite for not taking care of their health. 5. Few could read the labels – only 9,6%. The remaining over 90 % do not understand the labels. 6. Gender wise – women are more responsible and have higher health education. Conclusions: The lack of health education and care, using the lack of time as an excuse, as well as the reluctance to compromise and deprivation for health’s sake, demonstrate the lack of sustainability of health care system with respect to health education and promotion.
Martin, Graham P; Weaver, Simon; Currie, Graeme; Finn, Rachael; McDonald, Ruth
The need for organizational innovation as a means of improving health-care quality and containing costs is widely recognized, but while a growing body of research has improved knowledge of implementation, very little has considered the challenges involved in sustaining change - especially organizational change led 'bottom-up' by frontline clinicians. This study addresses this lacuna, taking a longitudinal, qualitative case-study approach to understanding the paths to sustainability of four organizational innovations. It highlights the importance of the interaction between organizational context, nature of the innovation and strategies deployed in achieving sustainability. It discusses how positional influence of service leads, complexity of innovation, networks of support, embedding in existing systems, and proactive responses to changing circumstances can interact to sustain change. In the absence of cast-iron evidence of effectiveness, wider notions of value may be successfully invoked to sustain innovation. Sustainability requires continuing effort through time, rather than representing a final state to be achieved. Our study offers new insights into the process of sustainability of organizational change, and elucidates the complement of strategies needed to make bottom-up change last in challenging contexts replete with competing priorities.
McGrath, Katherine M; Bennett, Denise M; Ben-Tovim, David I; Boyages, Steven C; Lyons, Nigel J; O'Connell, Tony J
*Clinical process redesign has enabled significant improvements in the delivery of health care services in emergency departments and elective surgery programs in New South Wales and at Flinders Medical Centre in South Australia, with tangible benefits for patients and staff. *The principles used in clinical process redesign are not new; they have been applied in other industries with significant gains for many years, but have only recently been introduced into health care systems. *Through experience with clinical process redesign, we have learnt much about the factors critical to the success of implementing and sustaining this process in the health care setting. *The key elements for success are leadership by senior executives, clinical leadership, team-based problem solving, a focus on the patient journey, access to data, ambitious targets, strong performance management, and a process for maintaining improvement.
Miller, Benjamin F; Ross, Kaile M; Davis, Melinda M; Melek, Stephen P; Kathol, Roger; Gordon, Patrick
The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet. However, challenges to implementing the PCMH framework are compounded for real-world practitioners because payment reform rarely happens concurrently. Nowhere is this more evident than in attempts to integrate behavioral health clinicians into primary care. As behavioral health clinicians find opportunities to work in integrated settings, a comprehensive understanding of payment models is integral to the dialogue. This article describes alternatives to the traditional fee for service (FFS) model, including modified FFS, pay for performance, bundled payments, and global payments (i.e., capitation). We suggest that global payment structures provide the best fit to enable and sustain integrated behavioral health clinicians in ways that align with the Triple Aim. Finally, we present recommendations that offer specific, actionable steps to achieve payment reform, complement PCMH, and support integration efforts through policy. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Buykx, Penny; Humphreys, John S; Tham, Rachel; Kinsman, Leigh; Wakerman, John; Asaid, Adel; Tuohey, Kathy
The ability to sustain comprehensive primary health care (PHC) services in the face of change is crucial to the health of rural communities. This paper illustrates how one service has proactively managed change to remain sustainable. A 6-year longitudinal evaluation of the Elmore Primary Health Service (EPHS) located in rural Victoria, Australia, is currently underway, examining the performance, quality and sustainability of the service. Threats to, and enablers of, sustainability have been identified from evaluation data (audit of service indicators, community surveys, key stakeholder interviews and focus groups) and our own observations. These are mapped against an overarching framework of service sustainability requirements: workforce organisation and supply; funding; governance, management and leadership; service linkages; and infrastructure. Four years into the evaluation, the evidence indicates EPHS has responded effectively to external and internal changes to ensure viability. The specific steps taken by the service to address risks and capitalise on opportunities are identified. This evaluation highlights lessons for health service providers, policymakers, consumers and researchers about the importance of ongoing monitoring of sentinel service indicators; being attentive to changes that have an impact on sustainability; maintaining community involvement; and succession planning.
McCabe, O Lee; Gwon, Howard S; McHugh, Paul R; Breakey, William R; Schwartz, Joseph M; Clark, Michael R; Kaminsky, Michael J
Health care reform has posed special challenges for departments of psychiatry in academic medical centers. This report describes one department's strategic responses to a marketplace with high penetration by managed care and provides examples of the kinds of faculty concerns that can arise when major departmental reorganizations are attempted. The department's successful adaptation to a radically altered professional environment is attributed to the following five initiatives: vertical integration and diversification of clinical programs, service line management, outcomes measurement, regional network development, and institutional managed care partnerships Although the authors did not design their adaptive efforts as a research study, they offer objective data to support their conclusion that the viability of their overall clinical enterprise has been sustained despite an external environment inhospitable to academic psychiatry.
Ireys, Henry T; Brach, Cindy; Anglin, Grace; Devers, Kelly J; Burton, Rachel
Introduction Under the CHIPRA Quality Demonstration Grant Program, CMS awarded $100 million through 10 grants that 18 state Medicaid agencies implemented between 2010 and 2015. The program's legislatively-mandated purpose was to evaluate promising ideas for improving the quality of children's health care provided through Medicaid and CHIP. As part of the program's multifaceted evaluation, this study examined the extent to which states sustained key program activities after the demonstration ended. Methods We identified 115 potentially sustainable elements within states' CHIPRA demonstrations and analyzed data from grantee reports and key informant interviews to assess sustainment outcomes and key influential factors. We also assessed sustainment of the projects' intellectual capital. Results 56% of potentially sustainable elements were sustained. Sustainment varied by topic area: Elements related to quality measure reporting and practice facilitation were more likely to be sustained than others, such as parent advisors. Broad contextual factors, the state's Medicaid environment, implementation partners' resources, and characteristics of the demonstration itself all shaped sustainment outcomes. Discussion Assessing sustainment of key elements of states' CHIPRA quality demonstration projects provides insight into the fates of the "promising ideas" that the grant program was designed to examine. As a result of the federal government's investment in this grant program, many demonstration states are in a strong position to extend and spread specific strategies for improving the quality of care for children in Medicaid and CHIP. Our findings provide insights for policymakers and providers working to improve the quality of health care for low income children.
Jeurissen, P P T; Ravesteijn, B A; Janssen, R T J M; Tanke, M A C
After a decade of robust growth in spending, Dutch mental healthcare is on a more stricter budgetary path since 2012. High prevalence of illness and limited spending, imply the need for efficient mental healthcare delivery. AIM: To advise how mental health care can be managed more efficiently. There will also have to be more differentiation between mild and serious psychiatric illnesses. METHOD: Review of academic articles and policy studies. RESULTS: With regard to the treatment of fairly common disorders, more attention needs to be given to integrated basic care and e-health. Employers and stakeholders can perhaps play a role in financing some of these services. Severe mental disorders can be handled more often on an integrated ambulatory basis setting than only in a hospital setting, while scaling down inpatient capacity. These steps would represent a major transition and would require spending cuts and a change in the provider 'landscape'. CONCLUSION: Sustainable mental healthcare is inseparably linked to an agenda that provides value for money and it implies a major transition. However, in principle, it should be possible to fit these changes into the current system of governance. More attention needs to be given to coordination between the various domains, and to a reduction in administrative costs. Reimbursement methods should align e-health, collaborative care, case-management and best-practice pathways.
'pressed out' and reduced waiting lists. Increased efficiency however, threatens equity in some specific aspects. Fee-for-service payment means increased production and so far even increased costs. If they are to be met with increased private financing, rather than with present tax financing, it will bring......Reforming health care systems which are predominantly publicly provided and financed has usually been motivated as a way of increasing efficiency even if it seldom is explicit whether it is in the official sense related to individual utility or in the unofficial sense related to health outcomes....... In the case of Sweden the welfare state has been made politically sustainable through a construction where cash benefits and service provision are tailored to satisfy not only the basic needs but even the more discriminating needs of the middle classes. Their loyalty with the taxes is politically crucial...
Annemarije L Kruis
> 2. In the Kroonluchter cohort, 56 subjects completed follow-up, were of mean age 69 years, with an FEV1/FVC ratio of 0.59, while their postbronchodilator FEV1 of 65% predicted was somewhat lower than in the total group. 6MWD improved significantly and in a clinically relevant manner up to 93 m at 12 months and was sustained at 83 m over 24 months; this effect occurred faster in patients with MRC dyspnea score > 2. In patients with baseline 6MWD < 400 m the improvement remained >100 m at 24 months.Conclusion: In this study, IDM improved and sustained health status and exercise capacity in primary care COPD patients during two years of follow-up. Improvements in health status are consistently higher in patients with CCQ > 1 at baseline, being strongest in patients with baseline MRC dyspnea score >2. Improvements in exercise capacity remain highest in patients with 6MWD < 400 m at baseline and seem to occur earlier in patients with MRC dyspnea score >2.Keywords: chronic obstructive pulmonary disease, disease management, integrated care, pulmonary rehabilitation, primary care
Fabian Ling Ngai Tung
Full Text Available Objectives: to explore nurses' knowledge of universal health coverage (UHC for inclusive and sustainable development of elderly care services. Method: this was a cross-sectional survey. A convenience sample of 326 currently practicing enrolled nurses (EN or registered nurses (RN was recruited. Respondents completed a questionnaire which was based on the implementation strategies advocated by the WHO Global Forum for Governmental Chief Nursing Officers and Midwives (GCNOMs. Questions covered the government initiative, healthcare financing policy, human resources policy, and the respondents' perception of importance and contribution of nurses in achieving UHC in elderly care services. Results: the knowledge of nurses about UHC in elderly care services was fairly satisfactory. Nurses in both clinical practice and management perceived themselves as having more contribution and importance than those in education. They were relatively indifferent to healthcare policy and politics. Conclusion: the survey uncovered a considerable knowledge gap in nurses' knowledge of UHC in elderly care services, and shed light on the need for nurses to be more attuned to healthcare policy. The educational curriculum for nurses should be strengthened to include studies in public policy and advocacy. Nurses can make a difference through their participation in the development and implementation of UHC in healthcare services.
Reforming health care systems which are predominantly publicly provided and financed has usually been motivated as a way of increasing efficiency even if it seldom is explicit whether it is in the official sense related to individual utility or in the unofficial sense related to health outcomes. In the case of Sweden the welfare state has been made politically sustainable through a construction where cash benefits and service provision are tailored to satisfy not only the basic needs but even the more discriminating needs of the middle classes. Their loyalty with the taxes is politically crucial and therefore their evaluation of the services in the welfarist sense equally important. That loyalty was however threatened in a situation where cost-containment policies were applied while equity principles were still a strong priority. Health care utilization was increasing among the very old and chronically ill while it was decreasing for other groups. The reforms introduced in some counties during the 1990s have been focussing on a purchaser-provider split and fee-for-service payment of providers. They have increased productivity sharply, increased utilization even among the groups that previously were 'pressed out' and reduced waiting lists. Increased efficiency however, threatens equity in some specific aspects. Fee-for-service payment means increased production and so far even increased costs. If they are to be met with increased private financing, rather than with present tax financing, it will bring the risk of inequities. Payment of hospitals through DRG systems means payment to providers for medical interventions with no incentives to deal with social consequences of illness. Inequities in health care can be related to the way health care deals with inequalities in health due to inequalities in living conditions or inequalities in living conditions due to ill health. In the short perspective the reforms may threaten equity in the second aspect, in the longer
Plochg, T.; Delnoij, D.M.J.; Hoogedoorn, N.P.C.; Klazinga, N.S.
Background: To improve health-care delivery, care providers must base their services on community health needs and create a seamless continuum of care in which these needs can be met. Though, it is not obvious that providers apply this vision. Experiments with regulated competition in the health
Garcés, Jorge; Ródenas, Francisco; Sanjosé, Vicente
In this paper we propose a social and health care model that offers alternatives to three problems arising in converging European welfare states, particularly in the southern nations: the rise in demand for services and features linked to the ageing process, the increase in dependency and the crisis of informal support. Development of the principles of social sustainability implies re-formulation of the regulatory, care, economic, administrative, cultural, and axiological framework enabling a response to the needs of long term care without compromising the welfare of future generations. Together with this principle, quality of life elevated to a subjective right directs attention towards the sphere closest to citizens, eliminating all barriers, which hamper exercise of this right. All of the above produces economic and social costs which must be accepted from a viewpoint of social co-responsibility, which brings with it the supply of welfare individually, without detriment to the exercise of state responsibility in guaranteeing a social protection system of a universal nature.
Kastner, Monika; Sayal, Radha; Oliver, Doug; Straus, Sharon E; Dolovich, Lisa
Chronic diseases are a significant public health concern, particularly in older adults. To address the delivery of health care services to optimally meet the needs of older adults with multiple chronic diseases, Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) uses a novel approach that involves patient home visits by trained volunteers to collect and transmit relevant health information using e-health technology to inform appropriate care from an inter-professional healthcare team. Health TAPESTRY was implemented, pilot tested, and evaluated in a randomized controlled trial (analysis underway). Knowledge translation (KT) interventions such as Health TAPESTRY should involve an investigation of their sustainability and scalability determinants to inform further implementation. However, this is seldom considered in research or considered early enough, so the objectives of this study were to assess the sustainability and scalability potential of Health TAPESTRY from the perspective of the team who developed and pilot-tested it. Our objectives were addressed using a sequential mixed-methods approach involving the administration of a validated, sustainability survey developed by the National Health Service (NHS) to all members of the Health TAPESTRY team who were actively involved in the development, implementation and pilot evaluation of the intervention (Phase 1: n = 38). Mean sustainability scores were calculated to identify the best potential for improvement across sustainability factors. Phase 2 was a qualitative study of interviews with purposively selected Health TAPESTRY team members to gain a more in-depth understanding of the factors that influence the sustainability and scalability Health TAPESTRY. Two independent reviewers coded transcribed interviews and completed a multi-step thematic analysis. Outcomes were participant perceptions of the determinants influencing the sustainability and scalability of Health TAPESTRY. Twenty
Dubé, Laurette; Jha, Srivardhini; Faber, Aida; Struben, Jeroen; London, Ted; Mohapatra, Archisman; Drager, Nick; Lannon, Chris; Joshi, P K; McDermott, John
This paper introduces convergent innovation (CI) as a form of meta-innovation-an innovation in the way we innovate. CI integrates human and economic development outcomes, through behavioral and ecosystem transformation at scale, for sustainable prosperity and affordable universal health care within a whole-of-society paradigm. To this end, CI combines technological and social innovation (including organizational, social process, financial, and institutional), with a special focus on the most underserved populations. CI takes a modular approach that convenes around roadmaps for real world change-a portfolio of loosely coupled complementary partners from the business community, civil society, and the public sector. Roadmaps serve as collaborative platforms for focused, achievable, and time-bound projects to provide scalable, sustainable, and resilient solutions to complex challenges, with benefits both to participating partners and to society. In this paper, we first briefly review the literature on technological innovation that sets the foundations of CI and motivates its feasibility. We then describe CI, its building blocks, and enabling conditions for deployment and scaling up, illustrating its operational forms through examples of existing CI-sensitive innovation. © 2014 The New York Academy of Sciences.
Under the subsidiarity principles of the EU Member States have always had great autonomy in organising their health care systems, contributing to the patchwork of different health care systems across the EU. However, due to the continuing economic and political crisis, an unprecedented - and
Kjӕrgård, Bente; Land, Birgit; Bransholm Pedersen, Kirsten
In the present article, we explore how sustainable development strategies and health promotion strategies can be bridged. The concept of the 'duality of structure' is taken as our starting point for understanding the linkages between health promotion and sustainable development, and for uncovering the structural properties or conditions which either enable or constrain sustainable public health initiatives. We argue that strategies towards health promotion are not sufficiently integrated with strategies for sustainable development, and thus political strategies aimed at solving health problems or sustainability problems may cause new, undesired and unforeseen environmental or health problems. First, we explore how the relation between health and sustainability is articulated in international policy documents. Next, we develop a model for understanding the relation between health promotion and sustainability. Third, we use examples from agriculture and food production to illustrate that health and sustainability are mutually enabling and constraining. We conclude that while the renewed focus on food security and food inequalities has brought the health and sustainability dimensions of the food system onto the political agenda, the conceptualization of duality between health and sustainability could be a new platform for a critical and theoretical stance towards the market-oriented food system strategy. Thinking along the lines of duality means that the integration of health promotion strategies and sustainable development strategies cannot be based on an approach to integration in which either health or sustainability is given precedence over the other. From a duality perspective, integration means conceiving sustainability from a health perspective and health from a sustainability perspective. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: email@example.com.
Land, Birgit; Pedersen, Kirsten Bransholm; Kjærgård, Bente
In the present article, we explore how sustainable development strategies and health promotion strategies can be bridged. The concept of the ‘duality of structure’ is taken as our starting point for understanding the linkages between health promotion and sustainable development, and for uncovering...... the structural properties or conditions which either enable or constrain sustainable public health initiatives. We argue that strategies towards health promotion are not sufficiently integrated with strategies for sustainable development, and thus political strategies aimed at solving health problems...... or sustainability problems may cause new, undesired and unforeseen environmental or health problems. First, we explore how the relation between health and sustainability is articulated in international policy documents. Next, we develop a model for understanding the relation between health promotion...
Baumgardt, Johanna; Moock, Jörn; Rössler, Wulf; Kawohl, Wolfram
Objective Cooperation, job satisfaction, and burn out risk are indicators of sustainability in mental health services. Thus they were assessed among registered medical specialists in outpatient mental health care in Germany. Method A postal survey consisting of three questionnaires about cooperation, job satisfaction, and burnout was carried out among all registered medical specialists in outpatient mental health care in Germany (n = 4,430). Results 14.1 % (n = 626) of the specialists responded to the survey. Quality and quantity of cooperation regarding mental health care services were rated diverse, job satisfaction was assessed medium to high, and burnout risk was low to medium. Higher job satisfaction correlated with good quality of cooperation, fewer years of practice, fewer patients' chronically ill, more patients who as well seek psychotherapy, and less time spent on cooperation. Low burn out risk correlated with good quality of cooperation, higher age, single practice setting and a higher amount of patients who as well seek psychotherapy. Conclusion Quality and quantity of cooperation in outpatient mental health care - especially regarding community mental health care institutions - should be fostered. Aspects to be considered to reinforce job satisfaction and minimize burn out risk are age, years of practice, quality and quantity of cooperation, practice setting, and the mixture of patients. © Georg Thieme Verlag KG Stuttgart · New York.
Samandar, R; Kleefield, S; Hammel, J; Mehta, M; Crone, R
As the cost and degree of training necessary to provide state of the art health care has increased throughout the world, the present challenge in health care is to establish institutions that are financially sound and responsive to the dynamic needs of the communities in which they exist. As public funds have diminished, the role of the private sector in estabhshing innovative health care institutions has increased. This paper reviews the case of the LV Prasad Eye Institute (LVPEI), an ophthalmologic institute in Hyderabad, India, that is financially sound and medically vital. With an annual budget of US$3 million, 180 000 patients are seen and 23 000 surgeries are performed at the Institute and its satellites each year. The Institute provides patient care at a ratio of 1:1 non-paying to paying patients through fee cross-subsidization. The Institute uses a combination of financial modalities, including donations, grants and fees to administer its non-patient care programs. Non-clinical programs of the Institute include a paramedical training program and a fellowship in ophthalmology, an internationally accredited eye bank for the preservation of corneal tissues, a rural out-reach and education program, a basic science and epidemiology program that directs health policy activities of the Institute and a rehabilitation program for patients with incurable visual deficits. To evaluate its effectiveness, LVPEI uses quality improvement measures, including patient surveys, post-operative outcomes studies and service utlization reviews. This case report of a privately-funded medical institution describes a successful model through which high-quality, equitable health care can be provided in a developing country. The LVPEI's active program of quality management, its academic commitment and programmatic relevance to the needs of its community should be modularized and replicated to establish equitable, efficient and effective health care institutions in the developing world.
De Rosis, Sabina; Nuti, Sabina
eHealth is expected to contribute in tackling challenges for health care systems. However, it also imposes challenges. Financing strategies adopted at national as well regional levels widely affect eHealth long-term sustainability. In a public health care system, the public actor is among the main "buyers" eHealth. However, public interventions have been increasingly focused on cost containment. How to match these 2 aspects? This article explores some central issues, mainly related to financial aspects, in the development of effective and valuable eHealth strategies in a public health care system: How can the public health care system (as a "buyer") improve long-term success and sustainability of eHealth solutions? What levers are available to match in the long period different interests of different stakeholders in the eHealth field? A case study was performed in the Region of Tuscany, Italy. According to our results, win-win strategies should be followed. Investments should take into account the need to long-term finance solutions, for sustaining changes in health care organizations for obtaining benefits. To solve the interoperability issues, the concept of the "platform approach" emerged, based on collaboration within and between organizations. Private sector as well as beneficiaries and final users of the eHealth solutions should participate in their design, provision, and monitoring. For creating value for all, the evidence gap and the financial needs could be addressed with a pull mechanism of funding, aimed at paying according to the outcomes produced by the eHealth solution, on the base of an ongoing monitoring, measurement, and evaluation of the outcomes. © 2017 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.
Wolf, Jason A.
What happens when researching the radical unveils the simplest of solutions? This article tells the story of the 2007 ISPI Annual Conference Encore Presentation, Healthcare, Heal Thyself, sharing the findings of an exploration into high-performance health care facilities and their relevance to all organizations today. It shows how to overcome…
Wang, Jason J; Sebek, Kimberly M; McCullough, Colleen M; Amirfar, Sam J; Parsons, Amanda S; Singer, Jesse; Shih, Sarah C
Studies showing sustained improvements in the delivery of clinical preventive services are limited. Fewer studies demonstrate sustained improvements among independent practices that are not affiliated with hospitals or integrated health systems. This study examines the continued improvement in clinical quality measures for a group of independent primary care practices using electronic health records (EHRs) and receiving technical support from a local public health agency. We analyzed clinical quality measure performance data from a cohort of primary care practices that implemented an EHR at least 3 months before October 2009, the study baseline. We assessed trends for 4 key quality measures: antithrombotic therapy, blood pressure control, smoking cessation intervention, and hemoglobin A1c (HbA1c) testing based on monthly summary data transmitted by the practices. Of the 151 practices, 140 were small practices and 11 were community health centers; average time using an EHR was 13.7 months at baseline. From October 2009 through October 2011, average rates increased for antithrombotic therapy (from 58.4% to 74.8%), blood pressure control (from 55.3% to 64.1%), HbA1c testing (from 46.4% to 57.7%), and smoking cessation intervention (from 29.3% to 46.2%). All improvements were significant. During 2 years, practices showed significant improvement in the delivery of several key clinical preventive services after implementing EHRs and receiving support services from a public health agency.
Full Text Available Introduction. Over the last several years, during the economic crisis, the Ministry of Health and the Republican Health Insurance Fund (RHIF have been faced with new challenges in the sphere of healthcare services financing both in the primary as well as other types of health insurance in the Republic of Serbia (RS. Objective. Analysis of costeffectiveness of two models of organization of home treatment and healthcare in the primary insurance, with evaluation of the cost sustainability of a single visit by the inhome therapy team. Methods. Economic evaluation of the cost of home treatment and healthcare provision in 2011 was performed. In statistical analysis, the methods of descriptive statistics were employed. The structure of fixed costs of home healthcare was developed according to the RS official norms, as well as fixed costs of providing services of home therapy by the Healthcare Centre "New Belgrade". The statement of account for provided home therapy services was made utilizing the RHIF price list. Results. The results showed that the cost of home healthcare and therapy of the heterogeneous population of patients in the Healthcare Centre "New Belgrade" was more costeffective in relation to the cost of providing home therapy services according to the RS official norms. Conclusion. Approved costs utilized when making a contract for services of home therapy and healthcare with the RHIF are not financially sustainable. It was shown that the price of 10 EUR for each home visit by the inhome therapy team enables sustainability of this form of providing healthcare services in RS.
Konstantinović, Dejan; Lazarević, Vesna; Milovanović, Valentina; Lapcević, Mirjana; Konstantinović, Vladan; Vuković, Mira
Over the last several years, during the economic crisis, the Ministry of Health and the Republican Health Insurance Fund (RHIF) have been faced with new challenges in the sphere of healthcare services financing both in the primary as well as other types of health insurance in the Republic of Serbia (RS). Analysis of cost-effectiveness of two models of organization of home treatment and healthcare in the primary insurance, with evaluation of the cost sustainability of a single visit by the in-home therapy team. Economic evaluation of the cost of home treatment and healthcare provision in 2011 was performed. In statistical analysis, the methods of descriptive statistics were employed. The structure of fixed costs of home healthcare was developed according to the RS official norms, as well as fixed costs of providing services of home therapy by the Healthcare Centre "New Belgrade". The statement of account for provided home therapy services was made utilizing the RHIF price list. The results showed that the cost of home healthcare and therapy of the heterogeneous population of patients in the Healthcare Centre "New Belgrade" was more cost-effective in relation to the cost of providing home therapy services according to the RS official norms. Approved costs utilized when making a contract for services of home therapy and healthcare with the RHIF are not financially sustainable. It was shown that the price of 10 EUR for each home visit by the in-home therapy team enables sustainability of this form of providing healthcare services in RS.
The most populous country in the world, China needs more health care. Shenmu's practices show that National Free Health Care (NFHC) system has played an active role in fulfilling the citizen's needs of health care, and alleviating the difficulties in affording the medical costs and seeing doctors. But NFHC system needs substantial financial supporting. It is worth in-depth discussing and reflecting on whether the NFHC system suits China's national conditions. The paper establishes the population age structure forecasting model and NFHC financial burden model by decomposition methodology and actuarial modelling. And it finds than the financial burden of NFHC system in Shenmu will be increased from 256.64 million Yuan to 656.04 million Yuan in 2013-2020, with the growth rate 12.45%. Meanwhile, the percentage of the financial burden in government's annual revenue is less than 2% in 2013-2020, NFHC system has financial sustainability in Shenmu. According to the successful experience abroad and the calculated results in Shenmu, to extend the NFHC system to the whole of China has financial sustainability and realistic possibility.
Full Text Available /AIDS Lab results access and medical history report; Nutritional planning and medication reminder Peru, Colecta-PALM: ART adherence information and patient?s behavioral actions that is potential to wide spread of HIV/AIDS South Africa, Cell... and the development of mobile phone-based applications for health care in developing countries such as South Africa, India, Rwanda, Peru, Uganda, etc . These applications fall in the following utilisation areas: Education and Awareness, Remote Data Collection...
Palmer, Jennifer J; Gilbert, Alice; Choy, Michelle; Blanchet, Karl
Little is known about the contributions of faith-based organisations (FBOs) to health systems in Africa. In the specialist area of eye health, international and domestic Christian FBOs have been important contributors as service providers and donors, but they are also commonly critiqued as having developed eye health systems parallel to government structures which are unsustainable. In this study, we use a health systems approach (quarterly interviews, a participatory sustainability analysis exercise and a social network analysis) to describe the strategies used by eye care practitioners in four hospitals of north-west Tanzania to navigate the government, church mission and donor rules that govern eye services delivery there. Practitioners in this region felt eye care was systemically neglected by government and therefore was 'all under the NGOs', but support from international donors was also precarious. Practitioners therefore adopted four main strategies to improve the sustainability of their services: (1) maintain 'sustainability funds' to retain financial autonomy over income; (2) avoid granting government user fee exemptions to elderly patients who are the majority of service users; (3) expand or contract outreach services as financial circumstances change; and (4) access peer support for problem-solving and advocacy. Mission-based eye teams had greater freedom to increase their income from user fees by not implementing government policies for 'free care'. Teams in all hospitals, however, found similar strategies to manage their programmes even when their management structures were unique, suggesting the importance of informal rules shared through a peer network in governing eye care in this pluralistic health system. Health systems research can generate new evidence on the social dynamics that cross public and private sectors within a local health system. In this area of Tanzania, Christian FBOs' investments are important, not only in terms of the population
Hoque, D M Emdadul; Arifeen, Shams E; Rahman, Muntasirur; Chowdhury, Enayet K; Haque, Twaha M; Begum, Khadija; Hossain, M Altaf; Akter, Tasnima; Haque, Fazlul; Anwar, Tariq; Billah, Sk Masum; Rahman, Ahmed Ehsanur; Huque, Md Hamidul; Christou, Aliki; Baqui, Abdullah H; Bryce, Jennifer; Black, Robert E
The Integrated Management of Childhood Illness (IMCI) strategy includes guidelines for the management of sick children at first-level facilities. These guidelines intend to improve quality of care by ensuring a complete assessment of the child's health and by providing algorithms that combine presenting symptoms into a set of illness classifications for management by IMCI-trained service providers at first-level facilities. To investigate the sustainability of improvements in under-five case management by two cadres of first-level government service providers with different levels of pre-service training following implementation of IMCI training and supportive supervision. Twenty first-level health facilities in the rural sub-district of Matlab in Bangladesh were randomly assigned to IMCI intervention or comparison groups. Health workers in IMCI facilities received training in case management and monthly supportive supervision that involved observations of case management and reinforcement of skills by trained physicians. Health workers in comparison facilities were supervised according to Government of Bangladesh standards. Health facility surveys involving observations of case management were carried out at baseline (2000) and at two points (2003 and 2005) after implementation of IMCI in intervention facilities. Improvement in the management of sick under-five children by IMCI trained service providers with only 18 months of pre-service training was equivalent to that of service providers with 4 years of pre-service training. The improvements in quality of care were sustained over a 2-year period across both cadres of providers in intervention facilities. IMCI training coupled with regular supervision can sustain improvements in the quality of child health care in first-level health facilities, even among workers with minimal pre-service training. These findings can guide government policy makers and provide further evidence to support the scale-up of regular
Andersen, Heidi Lene
Abstract: This article discusses how to accomplish a transition towards healthy and sustainable futures. Despite political statements and profound theoretical developments, little has happened in the field of practice. This article presents a number of problematics in the theoretical and conceptual...... development within the fields of sustainability and health promotion. With this objective in mind, this article seeks to find solutions to a question raised by the WHO health and sustainability researcher, Illona Kickbusch: ‘What conceptual framing and common language can help move a shared agenda forward...... departments. The article demonstrates that an action research approach including an Aristotelean phronetic perspective can be successful in integrating health and sustainability in research, as well as in practice. There are two main conclusions from the empirical case study. The first is that the common...
Harrison, Mark; Milbers, Katherine; Mihic, Tamara; Anis, Aslam H
Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.
Repullo, J R
The environment of severe cost containment has led to the active search of "internal sustainability" of health systems; the disinvestment in all non-value added services is one of the tools used. This article provides the taxonomy to identify ineffective, unsafe, unnecessary, unsuccessful, unkind and unwise care practices and discusses their implications in relation to patients ordered according to their severity, as well as the expected health gains of the intervention. Finally, the feasibility of those disinvestment policies is analysed according to macro-, middle, and micro-management scenarios. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.
Maughan, Daniel L; Patel, Alisha; Parveen, Tahmina; Braithwaite, Isobel; Cook, Jonathan; Lillywhite, Rob; Cooke, Matthew
Aim To assess the effects of a social prescribing service development on healthcare use and the subsequent economic and environmental costs. Social prescribing services for mental healthcare create links with support in the community for people using primary care. Social prescribing services may reduce future healthcare use, and therefore reduce the financial and environmental costs of healthcare, by providing structured psychosocial support. The National Health Service (NHS) is required to reduce its carbon footprint by 80% by 2050 according to the Climate Change Act (2008). This study is the first of its kind to analyse both the financial and environmental impacts associated with healthcare use following social prescribing. The value of this observational study lies in its novel methodology of analysing the carbon footprint of a service at the primary-care level. An observational study was carried out to assess the impact of the service on the financial and environmental impacts of healthcare use. GP appointments, psychotropic medications and secondary-care referrals were measured. Findings Results demonstrate no statistical difference in the financial and carbon costs of healthcare use between groups. Social prescribing showed a trend towards reduced healthcare use, mainly due to a reduction in secondary-care referrals compared with controls. The associations found did not achieve significance due to the small sample size leading to a large degree of uncertainty regarding differences. This study demonstrates that these services are potentially able to pay for themselves through reducing future healthcare costs and are effective, low-carbon interventions, when compared with cognitive behavioral therapy or antidepressants. This is an important finding in light of Government targets for the NHS to reduce its carbon footprint by 80% by 2050. Larger studies are required to investigate the potentials of social prescribing services further.
McLean, Heather S; Carriker, Charlene; Bordley, William Clay
The Joint Commission, the Centers for Disease Control and Prevention, and the World Health Organization challenge hospitals to achieve and sustain compliance with effective hand hygiene (HH) practice; however, many inpatient units fail to achieve a high level of reliability. The aim of the project was to increase and sustain health care worker (HCW) compliance with HH protocols from 87% (level of reliability [LOR] 1) to ≥95% (LOR 2) within 9 months on 2 pediatric inpatient units in an academic children's hospital. This study was a time-series, quality-improvement project. Interventions were tested through multiple plan-do-study-act cycles on 2 pediatric inpatient units. HH compliance audits of HCWs on these units were performed randomly each week by the hospital infection prevention program. Control charts of percentages of HCW HH compliance were constructed with 3-σ (data within 3 SDs from a mean) control limits. These control limits were adjusted after achieving significant improvements in performance over time. Charts were annotated with interventions including (1) increasing awareness, (2) providing timely feedback, (3) empowering patients and families to participate in mitigation, (4) providing focused education, and (5) developing interdisciplinary HH champions. HH compliance rates improved from an average of 87% (LOR 1) to ≥95% (LOR 2) within 9 months, and this improvement has been sustained for >2 years on both pediatric inpatient units. Significant and sustained gains in HH compliance rates of ≥95% (LOR 2) can be achieved by applying high-reliability human-factor interventions. Copyright © 2017 by the American Academy of Pediatrics.
Lavigne, John V; Feldman, Marissa; Meyers, Kathryn Mendelsohn
The Affordable Care Act has stimulated interest in screening for psychological problems in primary care. Given the scale with which screening might occur, the implications of a problem known as the base rate fallacy need to be considered. The concepts of sensitivity and specificity, positive and negative predictive value, and the base rate fallacy are discussed. The possibility that a screening program may not improve upon random selection is reviewed, as is the possibility that sequential screening might be useful. Developing effective screening programs for pediatric mental health problems is highly desirable, and properly addressing the high rate of false positives may improve the likelihood that such programs can be sustained. Consideration needs to be given to the use of sequential screening, which has both advantages and disadvantages, depending upon the type of problem to be screened for and the availability of resources for follow-up evaluations. © The Author 2016. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Full Text Available Viktoria Quehenberger, Martin Cichocki, Karl Krajic Health promoting Long term Care, Ludwig Boltzmann Institut Health Promotion Research, Vienna, Austria Background: Mobility is a main issue for health-related quality of life in old age. There is evidence for effects of physical activity (PA interventions on several dimensions of health for the aged and also, some specific evidence for vulnerable populations, like residents of residential aged care. Research on low-threshold PA interventions for users of residential aged care and documentation of their sustainability are scarce. “Low threshold” implies moderate demands on the qualification of trainers and low frequency of conduct, implying low demands on the health status and discipline of users. Yet the investigation of low-threshold interventions in residential aged care seems important as they might foster participation of users and implementation in everyday routines of provider organizations. An initial study (October 2011 to June 2012 had found intervention effects on health-related quality of life. The objective of this study was to examine sustainability of the effects of a low-threshold PA intervention on health-related quality of life in residential aged care. Methods: Data collection took place in three residential aged care homes in Vienna, Austria. At 1-year follow-up (June 2013, participants from the intervention group were interviewed using a standardized questionnaire. Using general mixed linear models and Friedman tests followed by paired t- and Wilcoxon signed-rank tests, we compared outcome measures at follow-up with measures obtained at baseline and at the end of the intervention.Results: At the 1-year follow-up assessment, participants’ (mean age 84.7 years; 89.7% female subjective health status was still significantly increased, equaling a small sustainable intervention effect (Cohen’s d=0.38, P=0.02. In comparison with baseline, a significant decline of reported
Gwynne, Kylie; Irving, Michelle J; McCowen, Debbie; Rambaldini, Boe; Skinner, John; Naoum, Steve; Blinkhorn, Anthony
A sustainable model of oral health care for disadvantaged Aboriginal people living in rural and remote communities in New South Wales was developed using collective impact methodology. Collective impact is a structured process which draws together organizations to develop a shared agenda and design solutions which are jointly resourced, measured and reported upon.
Harris, Claire; Green, Sally; Ramsey, Wayne; Allen, Kelly; King, Richard
This is the ninth in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The disinvestment literature has broadened considerably over the past decade; however there is a significant gap regarding systematic, integrated, organisation-wide approaches. This debate paper presents a discussion of the conceptual aspects of disinvestment from the local perspective. Four themes are discussed: Terminology and concepts, Motivation and purpose, Relationships with other healthcare improvement paradigms, and Challenges to disinvestment. There are multiple definitions for disinvestment, multiple concepts underpin the definitions and multiple alternative terms convey these concepts; some definitions overlap and some are mutually exclusive; and there are systematic discrepancies in use between the research and practice settings. Many authors suggest that the term 'disinvestment' should be avoided due to perceived negative connotations and propose that the concept be considered alongside investment in the context of all resource allocation decisions and approached from the perspective of optimising health care. This may provide motivation for change, reduce disincentives and avoid some of the ethical dilemmas inherent in other disinvestment approaches. The impetus and rationale for disinvestment activities are likely to affect all aspects of the process from identification and prioritisation through to implementation and evaluation but have not been widely discussed. A need for mechanisms, frameworks, methods and tools for disinvestment is reported. However there are several health improvement paradigms with mature frameworks and validated methods and tools that are widely-used and well-accepted in local health services that already undertake disinvestment-type activities and could be expanded and built upon. The nature of disinvestment brings some particular challenges for policy
Provider Perspectives on Advance Care Planning Documentation in the Electronic Health Record: The Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment.
Dillon, Ellis; Chuang, Judith; Gupta, Atul; Tapper, Sharon; Lai, Steve; Yu, Peter; Ritchie, Christine; Tai-Seale, Ming
Advance care planning (ACP) is valued by patients and clinicians, yet documenting ACP in an accessible manner is problematic. In order to understand how providers incorporate electronic health record (EHR) ACP documentation into clinical practice, we interviewed providers in primary care and specialty departments about ACP practices (n = 13) and analyzed EHR data on 358 primary care providers (PCPs) and 79 specialists at a large multispecialty group practice. Structured interviews were conducted with 13 providers with high and low rates of ACP documentation in primary care, oncology, pulmonology, and cardiology departments. The EHR problem list data on Advance Health Care Directives (AHCDs) and Physician Orders for Life-Sustaining Treatment (POLST) were used to calculate ACP documentation rates. Examining seriously ill patients ≥65 years with no preexisting ACP documentation seen by providers during 2013 to 2014, 88.6% (AHCD) and 91.1% (POLST) of 79 specialists had zero ACP documentations. Of 358 PCPs, 29.1% (AHCD) and 62.3% (POLST) had zero ACP documentations. Interviewed PCPs often believed ACP documentation was beneficial and accessible, while specialists more often did not. Specialists expressed more confusion about documenting ACP, whereas PCPs reported standard clinic workflows. Problems with interoperability between outpatient and inpatient EHR systems and lack of consensus about who should document ACP were sources of variations in practices. Results suggest that providers desire standardized workflows for ACP discussion and documentation. New Medicare reimbursement for ACP and an increasing number of quality metrics for ACP are incentives for health-care systems to address barriers to ACP documentation.
Harris, Claire; Allen, Kelly; King, Richard; Ramsey, Wayne; Kelly, Cate; Thiagarajan, Malar
This is the second in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Rising healthcare costs, continuing advances in health technologies and recognition of ineffective practices and systematic waste are driving disinvestment of health technologies and clinical practices that offer little or no benefit in order to maximise outcomes from existing resources. However there is little information to guide regional health services or individual facilities in how they might approach disinvestment locally. This paper outlines the investigation of potential settings and methods for decision-making about disinvestment in the context of an Australian health service. Methods include a literature review on the concepts and terminology relating to disinvestment, a survey of national and international researchers, and interviews and workshops with local informants. A conceptual framework was drafted and refined with stakeholder feedback. There is a lack of common terminology regarding definitions and concepts related to disinvestment and no guidance for an organisation-wide systematic approach to disinvestment in a local healthcare service. A summary of issues from the literature and respondents highlight the lack of theoretical knowledge and practical experience and provide a guide to the information required to develop future models or methods for disinvestment in the local context. A conceptual framework was developed. Three mechanisms that provide opportunities to introduce disinvestment decisions into health service systems and processes were identified. Presented in order of complexity, time to achieve outcomes and resources required they include 1) Explicit consideration of potential disinvestment in routine decision-making, 2) Proactive decision-making about disinvestment driven by available evidence from published research and local data, and 3) Specific exercises in
Okungu, Vincent; Chuma, Jane; McIntyre, Di
The need to provide quality and equitable health services and protect populations from impoverishing health care costs has pushed universal health coverage (UHC) to the top of global health policy agenda. In many developing countries where the majority of the population works in the informal sector, there are critical debates over the best financing mechanisms to progress towards UHC. In Kenya, government health policy has prioritized contributory financing strategy (social health insurance) as the main financing mechanism for UHC. However, there are currently no studies that have assessed the cost of either social health insurance (SHI) as the contributory approach or an alternative financing mechanism involving non-contributory (general tax funding) approaches to UHC in Kenya. The aim of this study was to critically assess the financial requirements of both contributory and non-contributory mechanisms to financing UHC in Kenya in the context of large informal sector populations. SimIns Basic® model, Version 2.1, 2008 (WHO/GTZ), was used to assess the feasibility of UHC in Kenya and provide estimates of financial resource needs for UHC over a 17-year period (2013-2030). Data sources included review of national and international literature on inflation, demography, macro-economy, health insurance, health services unit costs and utilization rates. The data were triangulated across geographic regions for accuracy and integrity of the simulation. SimIns models for 10 years only so data from the final year of the model was used to project for another 7 years. The 17-year period was necessary because the Government of Kenya aims to achieve UHC by 2030. The results show that SHI is financially sustainable (Sustainability in this study is used to mean that expenditure does not outstrip revenue.) (revenues and expenditure match) within the first five years of implementation, but it becomes less sustainable with time. Modelling for a non-contributory scenario, on the
Harris, Claire; Green, Sally; Elshaug, Adam G
This is the tenth in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. After more than a decade of research, there is little published evidence of active and successful disinvestment. The paucity of frameworks, methods and tools is reported to be a factor in the lack of success. However there are clear and consistent messages in the literature that can be used to inform development of a framework for operationalising disinvestment. This paper, along with the conceptual review of disinvestment in Paper 9 of this series, aims to integrate the findings of the SHARE Program with the existing disinvestment literature to address the lack of information regarding systematic organisation-wide approaches to disinvestment at the local health service level. A framework for disinvestment in a local healthcare setting is proposed. Definitions for essential terms and key concepts underpinning the framework have been made explicit to address the lack of consistent terminology. Given the negative connotations of the word 'disinvestment' and the problems inherent in considering disinvestment in isolation, the basis for the proposed framework is 'resource allocation' to address the spectrum of decision-making from investment to disinvestment. The focus is positive: optimising healthcare, improving health outcomes, using resources effectively. The framework is based on three components: a program for decision-making, projects to implement decisions and evaluate outcomes, and research to understand and improve the program and project activities. The program consists of principles for decision-making and settings that provide opportunities to introduce systematic prompts and triggers to initiate disinvestment. The projects follow the steps in the disinvestment process. Potential methods and tools are presented, however the framework does not stipulate project design or conduct; allowing
Macfarlane, Michael Alex
In the current period of health industry reform, accountable care organizations (ACOs) have emerged as a new model for the delivery of high-quality and cost-effective healthcare. However, few ACOs operate in direct competition with one another, and the accountable care business model has yet to present a means of continually developing new marginal value for patients and network partners. With value-based purchasing and patient consumerism strengthening as market forces, ACOs must build organizational sustainability and competitive advantage to meet the value demands set by customers and competitors. This essay proposes a strategy, adapted from the disciplines of agile software development and Lean product development, through which ACOs can engage internal and external customers in the development of new products that will provide sustainability and competitive advantage to the organization by decreasing waste in development, promoting specialized knowledge, and closely targeting customer value.
Madsen, Katrine Dahl; Nordin, Lone Lindegard; Simovska, Venka
in Denmark with its aims of ensuring overall school improvement, increasing pupil wellbeing and improving academic outcomes. Analysis of international policy documents, as well as of research literature in both fields, shows that school-based health education (HE) and education for sustainable development...... in this chapter focuses on a common tendency when health and sustainability education in schools are framed in national action plans: certain critical educational aspects are lost by narrowing the concepts of health and sustainability to fit particular school subjects (e.g. physical education or science......This chapter addresses the relationships between international and national (Danish) policies regarding sustainability and health promotion which have the potential to affect school-based health education/promotion and education for sustainable development. Based on policy mapping and analysis...
Borgonovi, Elio; Compagni, Amelia
The sustainability of health care systems, particularly those supporting universal health care, is a matter of current discussion among policymakers and scholars. In this article, we summarize the controversies around the economic sustainability of health care. We attempt to extend the debate by including a more comprehensive conceptualization of sustainability in relation to health care systems and by examining the dimensions of social and political sustainability. In conclusion, we argue that policymakers when taking decisions around universal health care should carefully consider issues of social, political, and economic sustainability, their interaction, and often their inherent trade-offs. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Brolan, Claire E; Forman, Lisa; Dagron, Stéphanie; Hammonds, Rachel; Waris, Attiya; Latif, Lyla; Ruano, Ana Lorena
Under the Millennium Development Goals (MDGs), United Nations (UN) Member States reported progress on the targets toward their general citizenry. This focus repeatedly excluded marginalized ethnic and linguistic minorities, including people of refugee backgrounds and other vulnerable non-nationals that resided within a States' borders. The Sustainable Development Goals (SDGs) aim to be truly transformative by being made operational in all countries, and applied to all, nationals and non-nationals alike. Global migration and its diffuse impact has intensified due to escalating conflicts and the growing violence in war-torn Syria, as well as in many countries in Africa and in Central America. This massive migration and the thousands of refugees crossing borders in search for safety led to the creation of two-tiered, ad hoc, refugee health care systems that have added to the sidelining of non-nationals in MDG-reporting frameworks. We have identified four ways to promote the protection of vulnerable non-nationals' health and well being in States' application of the post-2015 SDG framework: In setting their own post-2015 indicators the UN Member States should explicitly identify vulnerable migrants, refugees, displaced persons and other marginalized groups in the content of such indicators. Our second recommendation is that statisticians from different agencies, including the World Health Organization's Gender, Equity and Human Rights programme should be actively involved in the formulation of SDG indicators at both the global and country level. In addition, communities, civil society and health justice advocates should also vigorously engage in country's formulation of post-2015 indicators. Finally, we advocate that the inclusion of non-nationals be anchored in the international human right to health, which in turn requires appropriate financing allocations as well as robust monitoring and evaluation processes that can hold technocratic decision-makers accountable for
Ferrelli, Rita Maria; De Santis, Marta; Egle Gentile, Amalia; Taruscio, Domenica
The paper is addressing aspects of health system sustainability for rare diseases in relation to the current economic crisis and equity concerns. It takes into account the results of the narrative review carried out in the framework of the Joint Action for Rare Diseases (Joint RD-Action) "Promoting Implementation of Recommendations on Policy, Information and Data for Rare Diseases", that identified networks as key factors for health systems sustainability for rare diseases. The legal framework of European Reference Networks and their added value is also presented. Networks play a relevant role for health systems sustainability, since they are based upon, pay special attention to and can intervene on health systems knowledge development, partnership, organizational structure, resources, leadership and governance. Moreover, sustainability of health systems can not be separated from the analysis of the context and the action on it, including fiscal equity. As a result of the financial crisis of 2008, cuts of public health-care budgets jeopardized health equity, since the least wealthy suffered from the greatest health effects. Moreover, austerity policies affected economic growth much more adversely than previously believed. Therefore, reducing public health expenditure not only is going to jeopardise citizens' health, but also to hamper fair and sustainable development.
Meads, Geoffrey; Jones, Isabel; Harrison, Rachel; Forman, Dawn; Turner, Warren
The principal aim of this article is to promote the more effective integration of interprofessional learning with practice developments in health and social care. Ten specific recommendations are offered for the successful management of recent central policies for collaboration at the interface of the higher education and service sectors.…
Ankrah Odame, Emmanuel; Akweongo, Patricia; Yankah, Ben; Asenso-Boadi, Francis; Agyepong, Irene
Sustainability of public social welfare programmes has long been of concern in development circles. An important aspect of sustainability is the ability to sustain the recurrent financial costs of programmes. A free maternal care programme (FMCP) was launched under the Ghana National Health Insurance Scheme (NHIS) in 2008 with a start-up grant from the British Government. This article examines claims expenditure under the programme and the implications for the financial sustainability of the programme, and the lessons for donor and public financing of social welfare programmes. Records of reimbursement claims for services and medicines by women benefitting from the policy in participating facilities in one sub-metropolis in Ghana were analysed to gain an understanding of the expenditure on this programme at facility level. National level financial inflow and outflow (expenditure) data of the NHIS, related to implementation of this policy for 2008 and 2009, were reviewed to put the facility-based data in the national perspective. A total of US$936 450.94 was spent in 2009 by the scheme on FMCP in the sub-metropolis. The NHIS expenditure on the programme for the entire country in 2009 was US$49.25 million, exceeding the British grant of US$10.00 million given for that year. Subsequently, the programme has been entirely financed by the National Health Insurance Fund. The rapidly increasing, recurrent demands on this fund from the maternal delivery exemption programme-without a commensurate growth on the amounts generated annually-is an increasing threat to the sustainability of the fund. Provision of donor start-up funding for programmes with high recurrent expenditures, under the expectation that government will take over and sustain the programme, must be accompanied by clear long-term analysis and planning as to how government will sustain the programme.
Kamei, Tomoko; Takahashi, Keiko; Omori, Junko; Arimori, Naoko; Hishinuma, Michiko; Asahara, Kiyomi; Shimpuku, Yoko; Ohashi, Kumiko; Tashiro, Junko
this study developed a people-centered care (PCC) partnership model for the aging society to address the challenges of social changes affecting people's health and the new role of advanced practice nurses to sustain universal health coverage. a people-centered care partnership model was developed on the basis of qualitative meta-synthesis of the literature and assessment of 14 related projects. The ongoing projects resulted in individual and social transformation by improving community health literacy and behaviors using people-centered care and enhancing partnership between healthcare providers and community members through advanced practice nurses. people-centered care starts when community members and healthcare providers foreground health and social issues among community members and families. This model tackles these issues, creating new values concerning health and forming a social system that improves quality of life and social support to sustain universal health care through the process of building partnership with communities. a PCC partnership model addresses the challenges of social changes affecting general health and the new role of advanced practice nurses in sustaining UHC. o estudo desenvolveu um modelo de parceria de cuidados centrados nas pessoas (CCP) para uma sociedade que está envelhecendo, com o fim de enfrentar os desafios das mudanças sociais que afetam a saúde das pessoas e o novo papel da prática avançada de enfermagem para sustentar a cobertura universal de saúde. um modelo de parceria de cuidados centrados nas pessoas foi desenvolvido com base na meta-síntese qualitativa da literatura e a avaliação de 14 projetos relacionados. Os projetos em curso resultaram na transformação individual e social, melhorando a alfabetização de saúde da comunidade e comportamentos que usam o cuidado centrado nas pessoas e aumentando a parceria entre os profissionais de saúde e membros da comunidade por meio da prática avançada de enfermagem
Hooker, Leesa; Small, Rhonda; Taft, Angela
To investigate factors contributing to the sustained domestic violence screening and support practices of Maternal and Child Health nurses 2 years after a randomized controlled trial. Domestic violence screening by healthcare professionals has been implemented in many primary care settings. Barriers to screening exist and screening rates remain low. Evidence for longer term integration of nurse screening is minimal. Trial outcomes showed sustained safety planning behaviours by intervention group nurses. Process evaluation in 2-year follow-up of a cluster randomized controlled trial. Evaluation included a repeat online nurse survey and 14 interviews (July-September 2013). Survey analysis included comparison of proportionate group difference between arms and between trial baseline and 2 year follow-up surveys. Framework analysis was used to assess qualitative data. Normalization Process Theory informed evaluation design and interpretation of results. Survey response was 77% (n = 123/160). Sustainability of nurse identification of domestic violence appeared to be due to greater nurse discussion and domestic violence disclosure by women, facilitated by use of a maternal health and well-being checklist. Over time, intervention group nurses used the maternal checklist more at specific maternal health visits and found the checklist the most helpful resource assisting their domestic violence work. Nurses' spoke of a degree of 'normalization' to domestic violence screening that will need constant investment to maintain. Sustainable domestic violence screening and support outcomes can be achieved in an environment of comprehensive, nurse designed and theory driven implementation. Continuing training, discussion and monitoring of domestic violence work is needed to retain sustainable practices. © 2015 John Wiley & Sons Ltd.
Full Text Available With the achievements, failures and passing of the Millennium Development Goals (MDG, the world has turned its eyes to the Sustainable Development Goals (SDG, designed to foster sustainable social, economic and environmental development over the next 15 years.(1 Community-led initiatives are increasingly being recognised as playing a key role in realising sustainable community development and in the aspirations of universal healthcare.(2 In many parts of the world, faith-based organisations are some of the main players in community-led development and health care.(3 Community Health Global Network (CHGN creates links between organisations, with the purpose being to encourage communities to recognise their assets and abilities, identify shared concerns and discover solutions together, in order to define and lead their futures in sustainable ways.(4 CHGN has facilitated the development of collaborative groups of health and development initiatives called ‘Clusters’ in several countries including India, Bangladesh, Kenya, Tanzania, Zambia and Myanmar. In March 2016 these Clusters met together in an International Forum, to share learnings, experiences, challenges, achievements and to encourage one another. Discussions held throughout the forum suggest that the CHGN model is helping to promote effective, sustainable development and health care provision on both a local and a global scale.
The Physician Orders for Life-Sustaining Treatment (POLST) is a planning tool representative of an emerging paradigm aimed at facilitating elicitation of patient end-of-life care preferences. This study assessed the impact of the POLST document on provider goals and plans for conversations about end-of-life care treatment options. A 2 (POLST: experimental, control) × 3 (topic of possible patient misunderstanding: cardiopulmonary resuscitation, medical intervention, artificially administered nutrition) experimental design was used to assess goals, plan complexity, and strategies for plan alterations by medical professionals. Findings suggested that the POLST had little impact on plan complexity or reaction time with initial plans. However, preliminary evidence suggested that the utility of the POLST surfaced with provider responses to patient misunderstanding, in which differences in conditions were identified. Significant differences in goals reported as most important in driving conversational engagement emerged. Implications for findings are discussed.
vaccine for their children. journal of. COMMUNITY HEALTH. & PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26(2) 46-58. Correspondence to: Ijadunola M.Y. Department of Community Health, Faculty of Clinical Sciences,. College of Health Sciences, Obafemi Awolowo University,.
COMMUNITY HEALTH. & PRIMARY HEALTH CARE. KEYWORDS ABSTRACT. Correspondence to: Journal of Community Medicine and Primary Health Care. 26 (2) 1-6. Facility User's Preference between the Free and the Bamako. Initiative (Drug Revolving Fund-Based) Health Services in Iwajowa Local Government, Oyo ...
Carter, M.W.; Hans, Elias W.; Kolisch, R.
Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully
Background: Quality of care is a complex issue influenced by many factors. It is fundamental in assessing health care delivery in health facilities in developing countries. Health care workers' perceptions help policy makers and planners to identify bottlenecks in the system to improve utilisation and sustainability of health ...
Greenhalgh, Trisha; Wherton, Joseph; Papoutsi, Chrysanthi; Lynch, Jennifer; Hughes, Gemma; A'Court, Christine; Hinder, Susan; Fahy, Nick; Procter, Rob; Shaw, Sara
Many promising technological innovations in health and social care are characterized by nonadoption or abandonment by individuals or by failed attempts to scale up locally, spread distantly, or sustain the innovation long term at the organization or system level. Our objective was to produce an evidence-based, theory-informed, and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program. The study had 2 parallel components: (1) secondary research (hermeneutic systematic review) to identify key domains, and (2) empirical case studies of technology implementation to explore, test, and refine these domains. We studied 6 technology-supported programs-video outpatient consultations, global positioning system tracking for cognitive impairment, pendant alarm services, remote biomarker monitoring for heart failure, care organizing software, and integrated case management via data sharing-using longitudinal ethnography and action research for up to 3 years across more than 20 organizations. Data were collected at micro level (individual technology users), meso level (organizational processes and systems), and macro level (national policy and wider context). Analysis and synthesis was aided by sociotechnically informed theories of individual, organizational, and system change. The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback. The literature review identified 28 previous technology implementation frameworks, of which 14 had taken a dynamic systems approach (including 2 integrative reviews of previous work). Our empirical dataset consisted of over 400 hours of ethnographic observation, 165 semistructured interviews, and 200 documents. The final nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework included questions in 7 domains: the condition or illness, the technology
Oct 17, 2010 ... health and wide spread of social economic gap between families. Key words: Poverty, Eradication, Sustainability, Healthful Living, Global. Spread .... rich, water and sanitation related diseases are a major cause of ill health ..... health care education, public utilities or transportation are privatized, and the.
healthcare providers in south-east Nigerian. Malaria. National population commission and ORC Macro. Journal.2009;8:22. 6. Amaghionyeodiwe LA. Determinants of the. 15. World Health Organisation. The African choice of health care provider in Nigeria. Health malaria report 2003. Available at. Care Management Science.
Harris, Claire; Allen, Kelly; Waller, Cara; Green, Sally; King, Richard; Ramsey, Wayne; Kelly, Cate; Thiagarajan, Malar
This is the fifth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. This paper synthesises the findings from Phase One of the SHARE Program and presents a model to be implemented and evaluated in Phase Two. Monash Health, a large healthcare network in Melbourne Australia, sought to establish an organisation-wide systematic evidence-based program for disinvestment. In the absence of guidance from the literature, the Centre for Clinical Effectiveness, an in-house 'Evidence Based Practice Support Unit', was asked to explore concepts and practices related to disinvestment, consider the implications for a local health service and identify potential settings and methods for decision-making. Mixed methods were used to capture the relevant information. These included literature reviews; online questionnaire, interviews and structured workshops with a range of stakeholders; and consultation with experts in disinvestment, health economics and health program evaluation. Using the principles of evidence-based change, the project team worked with health service staff, consumers and external experts to synthesise the findings from published literature and local research and develop proposals, frameworks and plans. Multiple influencing factors were extracted from these findings. The implications were both positive and negative and addressed aspects of the internal and external environments, human factors, empirical decision-making, and practical applications. These factors were considered in establishment of the new program; decisions reached through consultation with stakeholders were used to define four program components, their aims and objectives, relationships between components, principles that underpin the program, implementation and evaluation plans, and preconditions for success and sustainability. The components were Systems and processes, Disinvestment projects, Support services, and
... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Vacation health care URL of this page: //medlineplus.gov/ency/article/001937.htm Vacation health care To use the ...
This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.
Bulger, R J
As prefigured in the Greek tragedy Antigone, one of the primary conflicts in contemporary health care is that between humane concern for the individual and concern for society at large and administrative rules. The computerization of the health care system and development of large data bases will create new forms of this conflict that will challenge the self-definition of health care and health care professionals.
K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)
textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a
Harris, Claire; Allen, Kelly; Waller, Cara; Dyer, Tim; Brooke, Vanessa; Garrubba, Marie; Melder, Angela; Voutier, Catherine; Gust, Anthony; Farjou, Dina
This is the seventh in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for resource allocation within a large Australian health service. It aimed to facilitate proactive use of evidence from research and local data; evidence-based decision-making for resource allocation including disinvestment; and development, implementation and evaluation of disinvestment projects. From the literature and responses of local stakeholders it was clear that provision of expertise and education, training and support of health service staff would be required to achieve these aims. Four support services were proposed. This paper is a detailed case report of the development, implementation and evaluation of a Data Service, Capacity Building Service and Project Support Service. An Evidence Service is reported separately. Literature reviews, surveys, interviews, consultation and workshops were used to capture and process the relevant information. Existing theoretical frameworks were adapted for evaluation and explication of processes and outcomes. Surveys and interviews identified current practice in use of evidence in decision-making, implementation and evaluation; staff needs for evidence-based practice; nature, type and availability of local health service data; and preferred formats for education and training. The Capacity Building and Project Support Services were successful in achieving short term objectives; but long term outcomes were not evaluated due to reduced funding. The Data Service was not implemented at all. Factors influencing the processes and outcomes are discussed. Health service staff need access to education, training, expertise and support to enable evidence-based decision-making and to implement and evaluate the changes arising from those decisions. Three support services were proposed based on research
Harris, Claire; Ko, Henry; Waller, Cara; Sloss, Pamela; Williams, Pamela
This is the fourth in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Healthcare decision-makers have sought to improve the effectiveness and efficiency of services through removal or restriction of practices that are unsafe or of little benefit, often referred to as 'disinvestment'. A systematic, integrated, evidence-based program for disinvestment was being established within a large Australian health service network. Consumer engagement was acknowledged as integral to this process. This paper reports the process of developing a model to integrate consumer views and preferences into an organisation-wide approach to resource allocation. A literature search was conducted and interviews and workshops were undertaken with health service consumers and staff. Findings were drafted into a model for consumer engagement in resource allocation which was workshopped and refined. Although consumer engagement is increasingly becoming a requirement of publicly-funded health services and documented in standards and policies, participation in organisational decision-making is not widespread. Several consistent messages for consumer engagement in this context emerged from the literature and consumer responses. Opportunities, settings and activities for consumer engagement through communication, consultation and participation were identified within the resource allocation process. Sources of information regarding consumer values and perspectives in publications and locally-collected data, and methods to use them in health service decision-making, were identified. A model bringing these elements together was developed. The proposed model presents potential opportunities and activities for consumer engagement in the context of resource allocation.
Haldeman, Scott; Nordin, Margareta; Outerbridge, Geoff
adequate care, World Spine Care (WSC) was established to "improve lives in underserved communities through sustainable, integrated, evidence-based, spinal care." WSC is comprised of volunteers and institutions from 6 continents and several countries, and incorporates a Board of Directors, an executive......) facilitation of opportunities for training graduate students in a variety of health-related fields. World Spine Care has (a) recognized the enormous need to establish clinical programs aimed at easing the suffering and disability associated with spinal disorders in resource-poor communities, (b) shown...
debut (20.8%), 40.8% had multiple sexual partners, 23.3% had sex under the influence of alcohol while. 34.2% didn't use ... PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26(2) 97-106. KEYWORDS. Risky sexual behaviour, young people, ..... 2010;15(1): Art. #505[cited consistent with ...
Up to 11 (7.2%) respondents in the non-BI LGA were not satisfied with the drug services in the health centers, compared ... improvement in primary health care services,. 8 ..... Naves J O, Silver LD. Evaluation of pharmaceutical assistance in public primary care in Brasilia, Brazil. Rev. Saude Publica. 2005; 39(2): 223-30. 21.
Younger, David S
China has recently emerged as an important global partner. However, like other developing nations, China has experienced dramatic demographic and epidemiologic changes in the past few decades. Population discontent with the health care system has led to major reforms. China's distinctive health care system, including its unique history, vast infrastructure, the speed of health reform, and economic capacity to make important advances in health care, nonetheless, has incomplete insurance coverage for urban and rural dwellers, uneven access, mixed quality of health care, increasing costs, and risk of catastrophic health expenditures. Copyright © 2016 Elsevier Inc. All rights reserved.
Younger, David S
Although a stated right for all Indians, equal access to health care in India is impeded by socioeconomic barriers. With its 3-tier system of public health care centers in villages, district hospitals, and tertiary care hospitals, government expenditure in India is inordinately low, with a disproportionate emphasis on private health spending. Accordingly, the poorest receive a minority of the available subsidies, whereas the richest obtain more than a third, fostering a divide in health care infrastructure across the rich and poor in urban and rural settings. This paradigm has implications for domestic Indian public health and global public health. Copyright © 2016 Elsevier Inc. All rights reserved.
Altman, David G.
Sustainability remains a key challenge in public health. The perspective article by Fagen and Flay adds to our understanding of technical factors associated with sustaining health interventions in schools. In this commentary, the Fagen and Flay article (2009) is considered within the broader literature on sustainability. By taking a broad view,…
... Caregivers Questions to Ask about Advanced Cancer Research Managing Cancer Care Finding Health Care Services Costs & Medical ... Feelings Planning for Advanced Cancer Advanced Cancer & Caregivers Managing Cancer Care Finding Health Care Services Managing Costs ...
Bogdanova, Ruta; Šilina, Maruta; Renigere, Ruta
In the 21st century, numerous complex challenges in education and health care have come to the fore, among them: 1) how to implement the ecological approach in the education process and health care practice; 2) how to implement study programmes in line with the education trends for "sustainable development" and the process of formation…
Navarro, Stephanie; Zirkle, Dorothy L; Barr, Donald A
The United States is facing a surge in the number of school-based health centers (SBHCs) owing to their success in delivering positive health outcomes and increasing access to care. To preserve this success, experts have developed frameworks for creating sustainable SBHCs; however, little research has affirmed or added to these models. This research seeks to analyze elements of sustainability in a case study of three SBHCs in San Diego, California, with the purpose of creating a research-based framework of SBHC sustainability to supplement expertly derived models. Using a mixed methods study design, data were collected from interviews with SBHC stakeholders, observations in SBHCs, and SBHC budgets. A grounded theory qualitative analysis and a quantitative budget analysis were completed to develop a theoretical framework for the sustainability of SBHCs. Forty-one interviews were conducted, 6 hours of observations were completed, and 3 years of SBHC budgets were analyzed to identify care coordination, community buy-in, community awareness, and SBHC partner cooperation as key themes of sustainability promoting patient retention for sustainable billing and reimbursement levels. These findings highlight the unique ways in which SBHCs gain community buy-in and awareness by becoming trusted sources of comprehensive and coordinated care within communities and among vulnerable populations. Findings also support ideas from expert models of SBHC sustainability calling for well-defined and executed community partnerships and quality coordinated care in the procurement of sustainable SBHC funding.
Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting.
Harris, Claire; Allen, Kelly; Brooke, Vanessa; Dyer, Tim; Waller, Cara; King, Richard; Ramsey, Wayne; Mortimer, Duncan
This is the sixth in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE program was established to investigate a systematic, integrated, evidence-based approach to disinvestment within a large Australian health service. This paper describes the methods employed in undertaking pilot disinvestment projects. It draws a number of lessons regarding the strengths and weaknesses of these methods; particularly regarding the crucial first step of identifying targets for disinvestment. Literature reviews, survey, interviews, consultation and workshops were used to capture and process the relevant information. A theoretical framework was adapted for evaluation and explication of disinvestment projects, including a taxonomy for the determinants of effectiveness, process of change and outcome measures. Implementation, evaluation and costing plans were developed. Four literature reviews were completed, surveys were received from 15 external experts, 65 interviews were conducted, 18 senior decision-makers attended a data gathering workshop, 22 experts and local informants were consulted, and four decision-making workshops were undertaken. Mechanisms to identify disinvestment targets and criteria for prioritisation and decision-making were investigated. A catalogue containing 184 evidence-based opportunities for disinvestment and an algorithm to identify disinvestment projects were developed. An Expression of Interest process identified two potential disinvestment projects. Seventeen additional projects were proposed through a non-systematic nomination process. Four of the 19 proposals were selected as pilot projects but only one reached the implementation stage. Factors with potential influence on the outcomes of disinvestment projects are discussed and barriers and enablers in the pilot projects are summarised. This study provides an in-depth insight into the experience of disinvestment
... medicines or supplements that you are taking WHY PREVENTIVE HEALTH CARE IS IMPORTANT Even if you feel ... want to schedule a visit . Another part of preventive health is learning to recognize changes in your ...
Early detection and treatment of these morbidities could prevent deterioration. The aim of the survey was to determine and compare the prevalence of ..... interventions. Increasing the detection rate of mental morbidity in the community is fundamental. The inclusion of mental health care as a component of primary health ...
large extent can reduce financial barriers to options; including government budgetary health care access ..... managers and demand-side factors, such as. International Health Conference. New adverse selection in ... patients in the scheme, and patient demand for. Information Centre. 1995. insured services. Many previous ...
Harris, Claire; Allen, Kelly; Waller, Cara; Brooke, Vanessa
This is the third in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Leaders in a large Australian health service planned to establish an organisation-wide, systematic, integrated, evidence-based approach to disinvestment. In order to introduce new systems and processes for disinvestment into existing decision-making infrastructure, we aimed to understand where, how and by whom resource allocation decisions were made, implemented and evaluated. We also sought the knowledge and experience of staff regarding previous disinvestment activities. Structured interviews, workshops and document analysis were used to collect information from multiple sources in an environmental scan of decision-making systems and processes. Findings were synthesised using a theoretical framework. Sixty-eight respondents participated in interviews and workshops. Eight components in the process of resource allocation were identified: Governance, Administration, Stakeholder engagement, Resources, Decision-making, Implementation, Evaluation and, where appropriate, Reinvestment of savings. Elements of structure and practice for each component are described and a new framework was developed to capture the relationships between them. A range of decision-makers, decision-making settings, type and scope of decisions, criteria used, and strengths, weaknesses, barriers and enablers are outlined. The term 'disinvestment' was not used in health service decision-making. Previous projects that involved removal, reduction or restriction of current practices were driven by quality and safety issues, evidence-based practice or a need to find resource savings and not by initiatives where the primary aim was to disinvest. Measuring resource savings is difficult, in some situations impossible. Savings are often only theoretical as resources released may be utilised immediately by patients waiting for beds, clinic
... map [a-z] More VA More VA Health Health Care Information A-Z Health Topic Finder My Health ... General QUICK LIST Apply for Benefits Apply for Health Care Prescriptions My Health e Vet eBenefits Life Insurance ...
Riel, A.C.R. van; Visser, L.M.; Eijk, M. van der; Faber, M.J.; Munneke, M.; Bloem, B.R.
Healthcare service providers in most Western societies are currently confronted with substantial challenges. They must continuously improve the quality of care, while at the same time being under substantial pressure from governments and insurance companies to reduce their costs and improve
Huffling, Katie; Schenk, Elizabeth
In acute care practice sites, the intensive care unit (ICU) is one of the most resource-intense environments. Replete with energy-intensive equipment, significant waste production, and multiple toxic chemicals, ICUs contribute to environmental harm and may inadvertently have a negative impact on the health of patients, staff, and visitors. This article evaluates the ICU on four areas of environmental sustainability: energy, waste, toxic chemicals, and healing environment and provides concrete actions ICU nurses can take to decrease environmental health risks in the ICU. Case studies of nurses making changes within their hospital practice are also highlighted, as well as resources for nurses starting to make changes at their health care institutions.
Abayomi, E Akinola; Landis, R Clive
HIV is targeting the developing nations of the world, threatening their economic development, overwhelming public health systems, and depleting human capital. The Caribbean is no exception, with the second highest incidence of HIV/AIDS outside Sub-Saharan Africa, sharing similar mixed fortunes from a postcolonial heritage, limited resources, and an HIV population dispersed in small population centers. Here we share the experience of Barbados, an island state of 280,000 people, in mounting a holistic and sustainable program against HIV/AIDS. At the forefront of this response has been the growth in clinical flow cytometry used for CD4 monitoring, which has prompted a welcome expansion in diagnostic capacity even beyond HIV/AIDS. A pan-Caribbean extension to Barbados' program has been the founding of the Caribbean Cytometry & Analytical Society (CCAS), which acts as a regional forum to accelerate technology transfer and develop the human resources needed to mount an effective response against HIV/AIDS. The 4th CCAS workshop in 2007 produced a consensus statement on the desirable characteristics for a "diagnostic dream machine": a simple-to-use, rugged flow cytometer capable of carrying out multiple diagnostic functions at the point of patient care in rural or island settings of the developing world, including CD4 count, blood count, and opportunistic infections, without the need for a supply cold-chain or dependable power source. It is our ambitious vision that the spread of flow cytometry, primarily to monitor CD4 in HIV/AIDS, can act as a Trojan horse to deliver better general and specialized diagnostic services to the developing world. Copyright 2008 Clinical Cytometry Society.
Podlekareva, Daria; Reekie, Joanne; Mocroft, Amanda
ABSTRACT: BACKGROUND: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four indicators of health care were...... assessed: Compliance with current guidelines on initiation of 1) combination antiretroviral therapy (cART), 2) chemoprophylaxis, 3) frequency of laboratory monitoring, and 4) virological response to cART (proportion of patients with HIV-RNA 90% of time on cART). RESULTS: 7097 Euro...... to North, patients from other regions had significantly lower odds of virological response; the difference was most pronounced for East and Argentina (adjusted OR 0.16[95%CI 0.11-0.23, p HIV health care utilization...
Leffers, Jeanne; Mitchell, Emma
Although nursing has a long history of service to the global community, the profession lacks a theoretical and empirical base for nurses to frame their global practice. A study using grounded theory methodology to investigate partnership and sustainability for global health led to the development of a conceptual model. Interviews were conducted with 13 global health nurse experts. Themes from the interviews were: components for engagement, mutual goal setting, cultural bridging, collaboration, capacity building, leadership, partnership, ownership, and sustainability. Next, the identified themes were reviewed in the literature in order to evaluate their conceptual relationships. Finally, careful comparison of the interview transcripts and the supporting literature led to the Conceptual Framework for Partnership and Sustainability in Global Health Nursing. The model posits that engagement and partnership must precede any planning and intervention in order to create sustainable interventions. This conceptual framework will offer nurses important guidance for global health nursing practice. © 2010 Wiley Periodicals, Inc.
Murphy, John W
Primary health care has received a lot of attention since the Alma Ata Conference, convened by the World Health Organization in 1978. Key to the strategy to improve health care outlined at the Alma Ata conference is citizen participation in every phase of service delivery. Although the goals of primary health care have not been achieved, the addition of narrative medicine may facilitate these ends. But a new epistemology is necessary, one that is compatible with narrative medicine, so that local knowledge is elevated in importance and incorporated into the planning, implementation, and evaluation of health programs. In this way, relevant, sustainable, and affordable care can be provided. The aim of this article is to discuss how primary health care might be improved through the introduction of narrative medicine into planning primary health care delivery.
Bowman, Darcia Harris
The Broad Acres clinic is one of 1,500 school-based health centers nationwide that bring a wide range of medical, nutritional, and mental-health care to millions of students and their families. The centers provide an important safety net for children and adolescents--particularly the more than 10 million today who lack health insurance, according…
The liberalization of health care in the course of three decades of ‘reform and opening up’ has given people in rural China access to a diverse range of treatment options, but the health care system has also been marred by accusations of price hikes, fake pharmaceuticals, and medical malpractice...... roads to healing. The recent introduction of new rural cooperative medicine in the township represents an attempt to bring the state back in and address popular concern with the cost and quality of health care. While superficially reminiscent of the traditional socialist system, this new state attempt...
Thompson, Michael; Cutler, Charles M
One of the contributing factors to both the increase in health care costs and the backlash to managed care was the lack of consumer awareness of the cost of health care service, the effect of health care costs on profits and wages, and the need to engage consumers more actively as consumers in health care decisions. This article reviews the birth of the health care consumerism movement and identifies gaps in health care consumerism today. The authors reveal some of the keys to building a sustainable health care consumerism framework, which involves enlisting consumers as well as other stakeholders.
Frank, Richard G.
National health care goals generally include providing broad access to appropriate amounts of high-quality health care at appropriate cost to the ultimate payers. Yet all countries, regardless of how they deliver and finance health care, struggle to achieve a sustainable balance among the implicit tradeoffs. Does this struggle stem from the limited scope for competition in health care or from information asymmetries? Or does it simply reflect the inherent difficulty of measuring health care o...
Pedersen, Kirsten Bransholm; Land, Birgit; Kjærgård, Bente
reduction and how these strategies affect the prospects for promoting health and sustainable food production and consumption. Danish food waste reduction strategies are used as examples with references to selected policy documents on food waste reduction strategies launched by international organisations...... sustainability and, vice versa, sustainability conditions health. Thus, to avoid unintended, negative effects the strategies directed towards sustainable development must be correlated with strategies for health promotion. The conceptual model is used to take a closer look at the complexities of food waste...... such as FAO, WHO, and the UN. We conclude that the strategies directed towards reducing food waste ignore the health and sustainability problems related to the oversupply of food. Neither do the Danish proponents of food waste reduction strategies explicitly articulate the built-in option to reduce the supply...
2Primary Health Care Department, Ikpoba Okha Local Government Area, Benin City, Nigeria. 1. 2. Adam V.Y , Iseh A.E. ABSTRACT. Introduction. The level of accurate knowledge adolescents have about HIV/AIDS, is important to enhance effective preventive actions, which ultimately result in a decrease in the incidence of ...
Enterobacter spp. 1. 0.6. Table V: Proportion of Respondent that enter the Ward with Handheld Device. Table VI: Proportion of Respondent that Disinfect Phones and what they Disinfect with. Table VII: Hand Hygiene Practices. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 27, NO 1, MARCH ...
globally, (Ischaemic heart diseases, Convention on Tobacco Control (FCTC), which. 5 cerebrovascular diseases, lower ... tract infections, chronic obstructive than 86% of the world's population. Tobacco pulmonary diseases ... and delivery of smoking cessation services among health care workers in Abuja. A cross sectional ...
Hollnagel, E.; Braithwaite, J.; Wears, R. L.
Health care is everywhere under tremendous pressure with regard to efficiency, safety, and economic viability - to say nothing of having to meet various political agendas - and has responded by eagerly adopting techniques that have been useful in other industries, such as quality management, lean...... production, and high reliability. This has on the whole been met with limited success because health care as a non-trivial and multifaceted system differs significantly from most traditional industries. In order to allow health care systems to perform as expected and required, it is necessary to have...... engineering's unique approach emphasises the usefulness of performance variability, and that successes and failures have the same aetiology. This book contains contributions from acknowledged international experts in health care, organisational studies and patient safety, as well as resilience engineering...
Jarzembski, W B
Today, health care engineering management is merely a concept of dreamers, with most engineering decisions in health care being made by nonengineers. It is the purpose of this paper to present a rationale for an integrated hospital engineering group, and to acquaint the clinical engineer with some of the salient features of management concepts. Included are general management concepts, organization, personnel management, and hospital engineering systems.
Oliveira, Beatriz Rosana Gonçalves de; Collet, Neusa; Viera, Cláudia Silveira
This study aims to reflect on humanization in health care, recovering the history of understanding about mankind, the human and humanity, until humanization in humanity and health. We discuss the national humanization program in hospital care and reflect on this proposal and on the issue of humanization in Brazilian health care nowadays. Communication is indispensable to establish humanization, as well as technical and material conditions. Both users and health professionals need to be heard, building a network of dialogues to think and promote singular humanization actions. For this process to take effect, there is a need to involve the whole that makes up the health service. This group involves different professionals, such as managers, public policy makers, professional councils and education institutions.
Winkler, Till J.; Ozturk, Pinar; Brown, Carol V.
HIOs that became operational during the SHIECAP grant period faced similar startup challenges, the two HIOs that demonstrated sustainability pursued distinct technology and sustainability strategies to develop HIE capabilities to fit their very different regional needs: an HIE capability to improve...... the population health of an underserved urban population, and an HIE capability to enable the transition to a healthcare landscape that rewards care coordination across suburban hospitals and physician practices. Conclusions: We propose two models of technology and sustainability strategies for developing bottom...
The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts is known as technology assessment. Technology policy makers can improve their decision making by becoming more aware, and taking greater advantage, of key trends in health care technology assessment (HCTA). HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance; clinical safety and efficacy/effectiveness; cost-effectiveness and other economic attributes; appropriate circumstances/indications for use; and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Among the important trends in HCTA are: (1) proliferation of HCTA groups in the public and private sectors; (2) higher standards for scientific evidence concerning technologies; (3) methodological development in cost analyses, health-related quality of life measurement, and consolidation of available scientific evidence (e.g., meta-analysis); (4) emphasis on improved data on how well technologies work in routine practice and for traditionally under-represented patient groups; (5) development of priority-setting methods; (6) greater reliance on medical informatics to support and disseminate HCTA findings.
Petrich, C.H.; Tonn, B.E.
Without the social will, no city can successfully Undertake the planning and programs necessary for meaningful progress toward sustainability. Social will derives from wellsprings of vital societal health. This paper presents an approach to helping cities in APEC member economies initiate a program for developing indicators of sustainability. Representative indicators of social capital and other aspects of civic engagement, as proxies for societal health, are presented.
Ngunyulu, R N; Peu, M D; Mulaudzi, F M; Mataboge, M L S; Phiri, S S
Collaborative HIV care between the nurses and traditional health practitioners is an important strategy to improve health care of people living with HIV. To explore and describe the views of nurses regarding collaborative HIV care in primary healthcare services in the City of Tshwane, South Africa. A qualitative, descriptive design was used to explore and describe the views of nurses who met the study's inclusion criteria. In-depth individual interviews were conducted to collect data from purposively selected nurses. Content analysis was used to analyse data. Two main categories were developed during the data analysis stage. The views of nurses and health system challenges regarding collaborative HIV care. The study findings revealed that there was inadequate collaborative HIV care between the nurses and the traditional health practitioners. It is evident that there is inadequate policy implementation, monitoring and evaluation regarding collaboration in HIV care. The study findings might influence policymakers to consider the importance of collaborative HIV care, and improve the quality of care by strengthening the referral system and follow-up of people living with HIV and AIDS, as a result the health outcomes as implied in the Sustainable Development Goals 2030 might be improved. Training and involvement of traditional health practitioners in the nursing and health policy should be considered to enhance and build a trustworthy working relationship between the nurses and the traditional health practitioners in HIV care. © 2017 International Council of Nurses.
This paper presents a short discussion of essential concepts in primary health care based on the Alma Ata Declaration of 1978 and a brief description of the Philippine Ministry of Health primary health program. The phrase primary health care implies that PHC is a package of goods to be delivered to people, whereas in fact it is an approach to health care which emphasizes community involvement and participation in health development. Community participation is too often taken to mean that communities should participate in programs designed, implemented, and run by health professionals. PHC however requires that health programs be designed, implemented, run by, and belong to the people of the community. External agencies and health professionals must find ways of becoming involved and participating in the community's programs. A thorough reorientation of health professionals, particularly doctors and nurses, away from technology and toward the ideals and wisdom of the people is needed if PHC is to succeed. PHC should provide the bridge between technological knowledge and indigenous wisdom. The national government is embarking on a nationwide PHC program, with structures being organized at national, regional, provincial, municipal, and barangay levels for PHC. The higher organizational levels are intended to ensure access to their available resources to complement resources at the lower levels, especially at the critical barangay level. Because over 70% of the national population lives in rural areas, the national government's effort through the Ministry of Health will stress rural needs and approaches. Different approaches will be needed for poor urban communities, and the Manila Health Department may be able to provide leadership for developing the new ideas needed to tailor health development programs to Filipino urban communities.
Weel, C. van; Schers, H.J.; Timmermans, A.
This article analyzes Dutch experiences of health care reform--in particular in primary care--with emphasis on lessons for current United States health care reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led health care and
Jacobsen, Christian Bøtcher; Andersen, Lotte Bøgh; Serritzlew, Søren
An important task in governing health services is to control costs. The literatures on both costcontainment and supplier induced demand focus on the effects of economic incentives on health care costs, but insights from these literatures have never been integrated. This paper asks how economic cost...... containment measures affect the utilization of health services, and how these measures interact with the number of patients per provider. Based on very valid register data, this is investigated for 9.556 Danish physiotherapists between 2001 and 2008. We find that higher (relative) fees for a given service...... make health professionals provide more of this service to each patient, but that lower user payment (unexpectedly) does not necessarily mean higher total cost or a stronger association between the number of patients per supplier and the health care utilization. This implies that incentives...
Scatena, João Henrique Gurtler; Viana, Ana Luiza d'Avila; Tanaka, Oswaldo Yoshimi
Brazil's Unified National Health System is financed according to a model known as fiscal federalism, the fund-sharing rules of the Social Security Budget, Ministry of Health norms, and Constitutional Amendment 29 (EC-29), which links Federal, State, and municipal resources to health. This article discusses the sustainability of public spending on health at the municipal level. Twenty-one municipalities were studied, using municipal budget data. From 1996 to 2006, total current per capita revenues increased by 280% above the accumulated inflation and Gross Domestic Product, varying by size of municipality, which also defined the composition of the municipal budgets. Meanwhile, the budget comprising the basis for EC-29 increased less (178%), thus placing limits on the municipal share of health spending. The results observed in these municipalities are believed to reflect the reality in thousands of other Brazilian municipalities, thus jeopardizing the capacity for municipal investment in health, especially beginning in 2008. The situation may become even worse, considering the repeal of the so-called Bank Transaction Tax (CPMF), Bills of Law 306/08 and 233/08 (currently under review in the National Congress), and the world recession stemming from the U.S. financial crisis.
and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). Medicaid is a federal and...living care. “Medicine has been slow to confront the very changes that it has been responsible for – or to apply the knowledge we already have about how...challenge to the nation. Challenges of the Industry As already outlined, a number of challenges confront the U.S. health care industry. Below are six
Marušič, Dorjan; Prevolnik Rupel, Valentina
In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.
Full Text Available In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.
Geary, Cara; Rosenthal, Susan L
The objectives of the study were (1) to evaluate self-reported stress levels and daily spiritual experiences in academic health care employees before, immediately after, and 1 year after enrolling in a mindfulness-based stress reduction (MBSR) course; and (2) to evaluate the correlation between a potential measure of pulse rate variability and self-reported stress levels. Fifty-nine (59) participants in the MBSR course offered to employees at the University of Texas Medical Branch in Galveston (UTMB) comprised the intervention group, and 94 health care providers in the neonatal nurseries comprised the control group. MBSR is an 8-week course that introduces mindfulness meditation practices. No intervention was offered to the control group. All participants were employees (or relatives of employees) at UTMB. All MBSR participants completed Cohen's Perceived Stress Scale, the SCL-90, the SF-36 Measure of Health and Well-Being, the Daily Spiritual Experiences Scale, and a 5-minute measure of pulse rate coherence. This testing was done before and after the MBSR course and 1 year later. Ninety-four (94) neonatal health care providers completed the same series of questionnaires and pulse rate variability (PRV) measures, with 49 of the 94 completing the questionnaires 2 months and 1 year later. MBSR participants improved on all measures except the physical component score of the SF-36 upon completion of the MBSR course, and these results were maintained at the 1-year follow-up. The control group did not significantly change on any of the measures. PRV as measured by the Heart Math system did not correlate with any of the self-report questionnaires. MBSR effectively reduces self-report measures of stress and increases daily spiritual experiences in employees in an academic health care setting, and these effects are stable for at least 1 year. Using a simple measure of PRV was not a clinically reliable biologic measure of stress.
Buss, Paulo Marchiori; Machado, Jorge Mesquita Huet; Gallo, Edmundo; Magalhães, Danielly de Paiva; Setti, Andréia Faraoni Freitas; Franco Netto, Francisco de Abreu; Buss, Daniel Forsin
The United Nations Conference on Sustainable Development, Rio+20, will address the challenges for sustainable development (SD), 'green economy and poverty eradication' and the 'institutional structure of sustainable development'. Therefore it will address the governance needed to achieve such goals. This paper discusses the structure of global, regional and national governance of and for health and environment in the context of SD. Among other global actions, the Millenium Development Goals were a significant recent political effort, but despite its advances, it fails when ignores the structural causes of production and consumption patterns and the unequal distribution of power, which are responsible for inequities and impede true development. To achieve SD, proposals must avoid reductionism, advancing conceptually and methodologically to face the challenges of the socio-environmental determinants of health through intersectoral action, including social participation and all levels of government. It is paramount to continue the implementation of Agenda 21, to meet the MDGs and to create 'Sustainable Development Goals'. Regarding the health field, Rio+20 Summit must reassure the connection between health and sustainability - as a part of the Social pillar of sustainable development - inspiring politics and actions in multiple levels.
Setegn, S. G.
Lack of adequate safe water, the pollution of the aquatic environment and the mismanagement of resources are major causes of ill-health and mortality, particularly in the developing countries. In order to accommodate more growth, sustainable fresh water resource management will need to be included in future development plans. One of the major environmental issues of concern to policy-makers is the increased vulnerability of ground water quality. The main challenge for the sustainability of water resources is the control of water pollution. To understand the sustainability of the water resources, one needs to understand the impact of future land use and climate changes on the natural resources. Providing safe water and basic sanitation to meet the Millennium Development Goals will require substantial economic resources, sustainable technological solutions and courageous political will. A balanced approach to water resources exploitation for development, on the one hand, and controls for the protection of health, on the other, is required if the benefits of both are to be realized without avoidable detrimental effects manifesting themselves. Meeting the millennium development goals for water and sanitation in the next decade will require substantial economic resources, sustainable technological solutions and courageous political will. In addition to providing "improved" water and "basic" sanitation services, we must ensure that these services provide: safe drinking water, adequate quantities of water for health, hygiene, agriculture and development and sustainable sanitation approaches to protect health and the environment.
Effective and Sustainable Health Research Partnerships : a Collaborative Canada-South Project. IDRC frequently supports collaborative Canada-South research on subjects of vital interest to developing countries, such as health. This project is concerned with learning how to structure and manage Canada-South research ...
Full Text Available Process Nursing Care (PAE is a systematic tool that facilitates the scientificity of care in community practice nurse, the application of scientific method in community practice, allows nursing to provide care in logical, systematic and comprehensive reassessing interventions to achieve the proposed results. It began with the valuation of Marjory Gordon Functional Patterns and then at the stage of diagnosis and planning North American Nursing Diagnosis Association (NANDA, Nursing Interventions Classification (NIC and Nursing Outcomes Classification (NOC is interrelate. It is a descriptive and prospective study. Diagnosis was made by applying the instruments measuring scale of the socio-demographic characteristics, symptom questionnaire for early detection of mental disorders in the community and appreciation for functional patterns. The PAE includes more frequent diagnoses, criteria outcomes, indicators, interventions and activities to manage community issues. alteration was evidenced in patterns: Adaptation and Stress Tolerance, Self-perception-Self-concept-, Role-Relationships, sleep and rest and Perception and Health Management. A standardized NANDA-NIC-NOC can provide inter care holistic care from the perspective of community mental health with a degree of scientific nature that frames the professional work projecting the individual, family and community care.
... Program SNF Requirements of Participation SNF Value-Based Purchasing (SNF VBP) Survey and Regulatory Therapy Services Workforce ... out, stay informed and spread. Looking for more information reguarding Prefered Provider Program Quality Care Book Store ... Nursing Home Administrator | Benedictine Health System US - MO - St. Louis, Qualifications Required: Bachelor’s degree ...
... Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. Related MedlinePlus Health Topics Home Care Services Browse the Encyclopedia A.D.A.M., ...
Vrangbæk, Karsten; Byrkjeflot, Haldor
adjustment of such frameworks. In this article we present a framework for analyzing accountability within health care. The paper makes use of the concept of "accountability regime" to signify the combination of different accountability forms, directions and functions at any given point in time. We show...
McAdoo, Joshua; Irving, Julian; Deslich, Stacie; Coustasse, Alberto
Before 2006, Massachusetts had more than 500 000 residents who lacked health insurance. Governor Mitt Romney enacted landmark legislation requiring all residents to obtain health insurance. Also, the legislation established a health insurance exchange for the purpose of broadening the choices of insurance plans made available to individuals in the state. The purpose of this research was to assess the Massachusetts health care reform in terms of access, cost, and sustainability. The methodology used was a literature review from 2006 to 2013; a total of 43 references were used. Health reform resulted in additional overall state spending of $2.42 billion on Medicaid for Massachusetts. Since the 2006 reform, 401 000 additional residents have obtained insurance. The number of Massachusetts residents who had access to health care increased substantially after the health care reform was enacted, to 98.1% of residents. The Massachusetts health care reform has not saved money for the state; its funding has been covered by Federal spending. However, reform has been sustained over time because of the high percentage of state residents who have supported the state mandate to obtain health care coverage.
de Zulueta PC
Paquita C de Zulueta Department of Primary Care and Public Health, Imperial College London, UK Abstract: Compassionate health care is universally valued as a social and moral good to be upheld and sustained. Leadership is considered pivotal for enabling the development and preservation of compassionate health care organizations. Strategies for developing compassionate health care leadership in the complex, fast-moving world of today will require a paradigm shift from the prevalent dehumanizi...
Full Text Available This article aims at deepening the theoretical foundations of the development of the health sector in the conditions of realization of the strategy of sustainable development of the state. Summarizes the notional and terminological apparatus of the modern economic science of health. Clarified categories “human health”, “public health”, “health”, “healthcare”, “health”, “development”, “sustainable development”. Introduced the concept of “sustainable development of the health sector”. The article generalises theoretical approaches to understanding issues in health care. Key words: health, human health, sustainable development, services.
Nyholm, Linda; Salmela, Susanne; Nyström, Lisbet; Koskinen, Camilla
While sustainability is a key concept in many different domains today, it has not yet been sufficiently emphasized in the healthcare sector. Earlier research shows that ethical values and evidence-based care models create sustainability in care practice. The aim of this study was to gain further understanding of the ethical values central to the realization of sustainability in care and to create an ethical practice model whereby these basic values can be made perceptible and active in care practice. Part of the ongoing "Ethical Sustainable Caring Cultures" research project, a hermeneutical application research design was employed in this study. Dialogues were used, where scientific researchers and co-researchers were given the opportunity to reflect on ethical values in relation to sustainability in care. An ethical practice model with ethos as its core was created from the results of the dialogues. In the model, ethos is encircled by the ethical values central to sustainability: dignity, responsibility, respect, invitation, and vows. The model can be used as a starting point for ethical conversations that support carers' reflections on the ethical issues seen in day-to-day care work and the work community, allowing ethical values to become visible throughout the entire care culture. It is intended as a tool whereby carers can more deeply understand an organization's common basic values and what they entail in regard to sustainability in care.
Internal Control Issues Controllership presents unique challenges within the overall rubric of the military health care system’s financial...sustainability. Controllership has been defined as a commitment to compliance, effectiveness, and integrity that spells out how each is to be achieved.23
Chin, Jean Lau; Yee, Barbara W K; Banks, Martha E
As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.
Environmental problems and their impact on health and welfare of the population, mainly the most deprived and excluded, from access to material and symbolic goods, provided only to a privileged minority, must be analyzed within the context of the global economic and financial crisis which swept the whole world since 2008. The collapse of the capitalist system and its negative impacts on production, income and employment provide evidence to the predatory nature of the underlying social and political relations which lead humanity to a catastrophic abyss whose consequences are felt on local, national and global levels. Appointing to the main aspects of environmental deterioration - greenhouse gases; pollution of rivers, lakes and oceans; the erosion and intoxication of soils; the lack of basic sanitation and fresh water supply in metropolitan areas, this essay refers to official health indicators published recently by the Ministry of Health of Brazil which documents destructive trends. Discussing the dysfunction and the paradoxes of capital accumulation the essay points out to the need for building a new development paradigm based on cooperation and solidarity; an equitable distribution of the social product and the reform of the political system leading from the present authoritarian patterns of social relations to a participative and a true democratic model.
Simona Catalina Stefan
Full Text Available Over the last decades, around the world, the concept of competitiveness was long debated by economists (and others, widely used and even sometimes overused. Although at the theoretical level, a number of determinant factors of health care organizations’ competitiveness have been proposed, their diversity and the little empirical data available argues for the need to create and validate a model of competitiveness of health organizations. The purpose of this paper is (considering the theoretical approach to shape a model of sustainable competitiveness of health organizations. In this respect, a 51 item questionnaire was designed and applied on a sample of 291 respondents from 12 Romanian health organizations. The exploratory factor analysis undertaken recovered more than 69% of the common variability of the initial 51 variables and revealed four factors/dimensions of sustainable competitiveness of health organizations (Economic Dimension, Quality Dimension, Social Dimension, and Strategic Dimension. Among the results of the exploratory factor analysis is also the empirical evidence on the contribution of leadership and managerial processes to enhance the influence of all other factors/dimensions in increasing the sustainable competitiveness of health organizations, thus bringing into focus the concept of sustainable management and leadership. Being just in the exploratory phase of our research, the proposed model can, and should, be improved, thus opening up further research directions.
Aabenhus, Mette Morre; Schriver, Michael; Kallestrup, Per
Global health interventions often focus on specific diseases, thus forming vertical programmes. Studies show that vertical programmes perform poorly, which underlines the need for a horizontal basis: universal community-based primary health care, which improves health equity and outcomes. The diagonal approach supports an integrated patient-centered health-care system. The ''15% by 2015''-initiative suggests that vertical programmes invest 15% of their budgets in strengthening integrated primary health care. Strategies depend on local context.
@hotmail.com, A.Ehigiegba@shell.com. KEYWORDS. Volunteer,. Obio Cottage. Hospital,. Participants,. Nigeria journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care.
... Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Types of health care providers URL of this page: //medlineplus.gov/ency/article/001933.htm Types of health care providers To ...
... medlineplus.gov/ency/patientinstructions/000878.htm Understanding your health care costs To use the sharing features on this ... This is the payment you make for certain health care provider visits and prescriptions. It is a set ...
Salmela, Susanne; Koskinen, Camilla; Eriksson, Katie
The aim of this study was to identify the distinctive foundations of the care culture and how nurse leaders (NL) can manage and strengthen these in a quest for ethically sustainable caring cultures. Sustainability presupposes an ethical leadership, a management of the good care and a well-educated staff, but research on NLs as managers of ethically sustainable caring cultures is not available. The study has a quantitative design with elements of a qualitative research approach. Data were collected through a web-based questionnaire sent to staff at eight selected units at a hospital in western Finland during September 2013; the reply rate was 32%. The data material was comprised of opinion questions, the ranking of values and two open-ended questions on lodestars in care and ethical principles in care work. NLs manage a care culture that rests on a solid foundation, where staff are co-creators of an ethically sustainable caring culture that includes good traditions for the praxis of care. NLs as managers are therefore responsible for realizing and passing on ethically sustainable caring cultures and creating prerequisites for staff's growth and development. The basis of good care, patient safety and sustainability is comprised of ethics with a respectful and dignified care that is evidence-based and economically stable. Through their management NLs have a responsibility to nurture and protect the core of caring and create contextual, professional and cultural prerequisites to maintain the core and art of caring as well as care staff's ethical and professional competence. © 2016 John Wiley & Sons Ltd.
Fadope, Cece Modupe; And Others
A series of articles that examine environmental health and discuss health care reform; connections between chlorine, chlorinated pesticides, and dioxins and reproductive disorders and cancers; the rise in asthma; connections between poverty and environmental health problems; and organizations for health care professionals who want to address…
Background: In a time of growing health expenditures and inefficiencies, ageing populations, rise of chronic diseases, co-morbity and technical evolutions, there is a worldwide quest for performant, innovative and sustainable health systems that are, a.o. effective and cost-efficient, patient-centric and co-creative and able to deal with the growing society dynamics.Problem statement: Effectively implementing strategic initiatives that tackle these challenges appears a frightening task since ...
Involving self-help groups in health-care institutions: the patients' contribution to and their view of 'self-help friendliness' as an approach to implement quality criteria of sustainable co-operation.
Nickel, Stefan; Trojan, Alf; Kofahl, Christopher
The importance of patient participation and involvement is now widely acknowledged; in the past, few systematic health-care institution policies existed to establish sustainable co-operation. In 2004, in Germany, the initiative 'Self-Help Friendliness (SHF) and Patient-Centeredness in Health Care' was launched to establish and implement quality criteria related to collaboration with patient groups. The objective of this study was to describe (i) how patients were involved in the development of SHF by summarizing a number of studies and (ii) a new survey on the importance and feasibility of SHF. In a series of participative studies, SHF was shaped, tested and implemented in 40 health-care institutions in Germany. Representatives from 157 self-help groups (SHGs), 50 self-help organizations and 17 self-help clearing houses were actively involved. The second objective was reached through a survey of 74 of the 115 member associations of the biggest self-help umbrella organization at federal level (response rate: 64 %). Patient involvement included the following: identification of the needs and wishes of SHGs regarding co-operation, their involvement in the definition of quality criteria of co-operation, having a crucial role during the implementation of SHF and accrediting health-care institutions as self-help friendly. The ten criteria in total were positively valued and perceived as moderately practicable. Through the intensive involvement of self-help representatives, it was feasible to develop SHF as a systematic approach to closer collaboration of professionals and SHGs. Some challenges have to be taken into account involving patients and the limitations of our empirical study. © 2016 The Authors. Health Expectations published by John Wiley & Sons Ltd.
Full Text Available Sustainable development in Romania can be achieved only through consensus orchestrated prioritizing people's attitudes and values. In order to achieve a maximum performance, cultural change must precede structural and functional changes, such an approach leading to a lasting transformation. Cultural change is not about social traditions, history, language, art, etc.., But those on the behavior, mentality, attitude towards work, economy and society. Sustainable development have to mean quality and achieve only limited natural capital, social and anthropogenic own or attracted. A drawing resources must be addressed by cost and their global rarity. Sustainable development for Romania, represents the effective management of resources in the national competitiveness and national foreign goods and services. Human health suppliers, health organizations that offer health services and those who need these services, meet on a market, called health services market, whose mechanism has features different from the other markets, not only from the point of view of the two forces, demand and supply, but also from the third party who pays. In the context of globalization, human development, defined as a process of people’s expanding possibilities to choose, cannot exist without an appropriate health. People often make choices in the economic, social and political fields, situated in the centre of development policies. From the human health perspective, attention is aimed at quality of the economic development, and not quantity, in three critical domains: expectation and quality of life, educational level and access to all the necessary economic resources in order to lead a decent life.
The Family Dental Health Care Service is a new approach that includes efforts to serve oral and dental patients that focuses on maintenance, improvement and protection. This oral and dental health approach uses basic dentistry science and technology. The vision of the Family Dental Health Care Service is the family independences in the effort of dental health maintenance and to achieve the highest oral and dental health degree as possible through family dentist care that is efficient, effecti...
Schieber, G J; Puollier, J P
Trends in health are reviewed for the member countries of the Organization for Economic Cooperation and Development (OECD) covering the following: the basic difficulties inherent in international comparative studies; the absolute levels of health expenditures in 1984; the levels and rates of growth of the health share in the gross domestic product (GDP) and the public share of total health expenditures; the elasticities of real health expenditures to real GDP for the 1960-75, 1975-84, and 1960-84 time periods; growth in health expenditures for the largest 7 OECD countries in terms of growth in population, health prices, health care prices in excess of overall prices, and utilization/intensity of services per person. International comparisons are a problem due to differences in defining the boundaries of the health sector, the heterogeneity of data, and methodological problems arising from comparing different economic, demographic, cultural, and institutional structures. The most difficult problem in international comparisons of health expenditures is lack of appropriate measures of health outcome. Exhibit 1 contains per capita health expenditures denominated in US dollars based on GDP purchasing power parities for 21 OECD countries for 1984. Per capita health expenditures ranged from less than $500 in Greece, Portugal, and Spain to over $1400 in Sweden and the US, with an OECD average of $871. After adjusting for price level differences, there still appears to be a greater than 3-fold difference in the "volume" of services consumed across the OECD countries. To determine if per capita health expenditures are related to a country's wealth as measured by its per capita GDP, the relationship between per capita health expenditures and per capita GDP for the 21 countries were examined for 1984. The data points and the "best fitting" trend line indicate a statistically significant relationship in which each $100 difference in per capita GDP is associated with a $10
Part II of Health Care Engineering begins with statistics on the occurrence of medical errors and adverse events, and includes some technological solutions. A chapter on electronic medical records follows. The knowledge management process divided into four steps is described; this includes a discussion on data acquisition, storage, and retrieval. The next two chapters discuss the other three steps of the knowledge management process (knowledge discovery, knowledge translation, knowledge integration and sharing). The last chapter briefly discusses usability studies and clinical trials.This two-
Hasman, Andreas; Hope, Tony; Østerdal, Lars Peter
The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precis......, the three interpretations provide a starting-point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs-based priority setting to social welfare maximisation...
... Adult Day Services Centers Home Health Care Hospice Care Nursing Home Care Residential Care Communities Screenings Mammography Pap ... Centers Hospice Care National Study of Long-Term Care Providers Nursing Home Care Residential Care Communities Centers for Medicare ...
Cesario, Sandra K
Women and children compose the largest segment of the more than 1 billion people worldwide who are unable to access needed health care services. To address this and other global health issues, the United Nations brought together world leaders to address growing health inequities, first by establishing the Millennium Development Goals in 2000 and more recently establishing Sustainable Development Goals, which are an intergovernmental set of 17 goals consisting of 169 targets with 304 indicators to measure compliance; they were designed to be applicable to all countries. Goal number 3, "Good Health and Well-Being: Ensure Heathy Lives and Promote Well-Being for All at All Ages," includes targets to improve the health of women and newborns. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.
Scheffer, Mário; Saluja, Saurabh; Alonso, Nivaldo
The current article examines surgical care as a public health issue and a challenge for health systems organization. When surgery fails to take place in timely fashion, treatable clinical conditions can evolve to disability and death. The Lancet Commission on Global Surgery defined indicators for monitoring sustainable universal access to surgical care. Applied to Brazil, the global indicators are satisfactory, but the supply of surgeries in the country is marked by regional and socioeconomic inequalities, as well as between the public and private healthcare sectors.
Bajracharya, Srijana M.
Environmental sustainability is the most visible recent global movement addressing the effect of human activities on the environment. Because of its effect on human health and well-being, it is imperative that the health education discipline begin to consider this topic as one of the important content areas. This paper provides a model for the…
Client Satisfaction with Antenatal Care Services in Primary Health Care. Centres in Sabon Gari Local Government Area, Kaduna State Nigeria. journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. 1. 1. 1. M.B Sufiyan , A.A Umar , A. Shugaba . 1Department of Community Medicine, Ahmadu Bello University, ...
Petrochuk, M A; Javalgi, R G
Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.
Vermeer, A. J. M.; van Assema, P.; Hesdahl, B.; Harting, J.; de Vries, N. K.
We assessed the perceived sustainability of community health programs organized by local intersectoral coalitions, as well as the factors that collaborating partners think might influence sustainability. Semi-structured interviews were conducted among 31 collaborating partners of 5 community health
Health care workers are exposed to many job hazards. These can include Infections Needle injuries Back injuries ... prevention practices. They can reduce your risk of health problems. Use protective equipment, follow infection control guidelines, ...
Cluver, Lucie D; Orkin, F Mark; Meinck, Franziska; Boyes, Mark E; Yakubovich, Alexa R; Sherr, Lorraine
The first policy action outlined in the Sustainable Development Goals (SDGs) is the implementation of national social protection systems. This study assesses whether social protection provision can impact 17 indicators of five key health-related SDG goals amongst adolescents in South Africa. We conducted a longitudinal survey of adolescents (10-18 years) between 2009 and 2012. Census areas were randomly selected in two urban and two rural health districts in two South African provinces, including all homes with a resident adolescent. Household receipt of social protection in the form of 'cash' (economic provision) and 'care' (psychosocial support) social protection, and health-related indicators within five SDG goals were assessed. Gender-disaggregated analyses included multivariate logistic regression, testing for interactions between social protection and socio-demographic covariates, and marginal effects models. Social protection was associated with significant adolescent risk reductions in 12 of 17 gender-disaggregated SDG indicators, spanning SDG 2 (hunger); SDG 3 (AIDS, tuberculosis, mental health and substance abuse); SDG 4 (educational access); SDG 5 (sexual exploitation, sexual and reproductive health); and SDG 16 (violence perpetration). For six of 17 indicators, combined cash plus care showed enhanced risk reduction effects. Two interactions showed that effects of care varied by poverty level for boys' hunger and girls' school dropout. For tuberculosis, and for boys' sexual exploitation and girls' mental health and violence perpetration, no effects were found and more targeted or creative means will be needed to reach adolescents on these challenging burdens. National social protection systems are not a panacea, but findings suggest that they have multiple and synergistic positive associations with adolescent health outcomes. Such systems may help us rise to the challenges of health and sustainable development.
Lucie D Cluver
Full Text Available The first policy action outlined in the Sustainable Development Goals (SDGs is the implementation of national social protection systems. This study assesses whether social protection provision can impact 17 indicators of five key health-related SDG goals amongst adolescents in South Africa.We conducted a longitudinal survey of adolescents (10-18 years between 2009 and 2012. Census areas were randomly selected in two urban and two rural health districts in two South African provinces, including all homes with a resident adolescent. Household receipt of social protection in the form of 'cash' (economic provision and 'care' (psychosocial support social protection, and health-related indicators within five SDG goals were assessed. Gender-disaggregated analyses included multivariate logistic regression, testing for interactions between social protection and socio-demographic covariates, and marginal effects models.Social protection was associated with significant adolescent risk reductions in 12 of 17 gender-disaggregated SDG indicators, spanning SDG 2 (hunger; SDG 3 (AIDS, tuberculosis, mental health and substance abuse; SDG 4 (educational access; SDG 5 (sexual exploitation, sexual and reproductive health; and SDG 16 (violence perpetration. For six of 17 indicators, combined cash plus care showed enhanced risk reduction effects. Two interactions showed that effects of care varied by poverty level for boys' hunger and girls' school dropout. For tuberculosis, and for boys' sexual exploitation and girls' mental health and violence perpetration, no effects were found and more targeted or creative means will be needed to reach adolescents on these challenging burdens.National social protection systems are not a panacea, but findings suggest that they have multiple and synergistic positive associations with adolescent health outcomes. Such systems may help us rise to the challenges of health and sustainable development.
Three interconnected and underpinning aspects of nanotechnology viz.: environment, human health, and sustainability are discussed. Sustainable development using nanomaterials by employing responsible manufacturing, principles of “green chemistry” by drastically reducing waste discharge and emission by-products; generation and storage of energy; development of lightweight yet mechanically strong components; development of bio-degradable goods — for medicine, waste disposal, containers, etc. and to monitor, detect, and remediate the environmental pollution are discussed. A brief discussion of fate and transport of nanomaterials in air, water, and soil; life-cycle analysis, and methodologies to conduct risk-assessment in the context of source reduction and conservation is introduced. It is expected that such emerging and potentially transformative studies will make a major contribution to improving the quality of the life of citizens worldwide, in particular in sectors such as environment and health care.
Full Text Available The financial sustainability of the health systems often reveals the ability of policy makers to finance healthcare in the face of growing cost pressures, with populations ageing, new technologies and increased patient expectations for healthcare coverage and quality. Thus, the healthcare systems need to reinvent themselves by using innovative financing mechanisms coupled with electronic information and communication systems, while offering greater transparency, flexibility and choice and increasing access to the services available. The paper analyses the healthcare financing models: the national health system, the social insurance or the private insurance model so that the Romanian health care reform should preserve the best elements of its existing system while selectively adapt techniques and processes that seemed to have been successful in other countries. Moreover, the application of information and communication technologies – eHealth offers new possibilities for improving almost every aspect of healthcare, from making medical systems more powerful and responsive to providing better health information to all.
G. Alan Tarr
Full Text Available President Barack Obama proposed a major overhaul of the American healthsystem, and in 2010 the U.S. Congress enacted his proposal, the PatientProtection and Affordable Care Act. Opponents of the Act challenged itsconstitutionality in federal court, claiming that it exceeds the powers grantedto the federal government under the Commerce Clause and the NecessaryProper Clause of the federal Constitution. Some courts have upheldthe law, but others have agreed with the critics, in particular ruling thatthe provision requiring citizens to buy health insurance is unconstitutional.Eventually the U.S. Supreme Court will rule on the issue. This article tracesthe controversy, surveys the interpretation of pertinent constitutional provisionsin past cases, analyzes the constitutional arguments presented byproponents and opponents of the Act, and concludes that the Act is constitutional.
Brown, Judith Belle; French, Reta; McCulloch, Amy; Clendinning, Eric
Abstract Objective To explore the knowledge and perceptions of fourth-year medical students regarding the new models of primary health care (PHC) and to ascertain whether that knowledge influenced their decisions to pursue careers in family medicine. Design Qualitative study using semistructured interviews. Setting The Schulich School of Medicine and Dentistry at The University of Western Ontario in London. Participants Fourth-year medical students graduating in 2009 who indicated family medicine as a possible career choice on their Canadian Residency Matching Service applications. Methods Eleven semistructured interviews were conducted between January and April of 2009. Data were analyzed using an iterative and interpretive approach. The analysis strategy of immersion and crystallization assisted in synthesizing the data to provide a comprehensive view of key themes and overarching concepts. Main findings Four key themes were identified: the level of students’ knowledge regarding PHC models varied; the knowledge was generally obtained from practical experiences rather than classroom learning; students could identify both advantages and disadvantages of working within the new PHC models; and although students regarded the new PHC models positively, these models did not influence their decisions to pursue careers in family medicine. Conclusion Knowledge of the new PHC models varies among fourth-year students, indicating a need for improved education strategies in the years before clinical training. Being able to identify advantages and disadvantages of the PHC models was not enough to influence participants’ choice of specialty. Educators and health care policy makers need to determine the best methods to promote and facilitate knowledge transfer about these PHC models. PMID:22518904
Full Text Available Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE; work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.
Demiglio, Lily; Williams, Allison M
This paper focuses on the sustainability of existing palliative care teams that provide home-based care in a shared care model. For the purposes of this study, following Evashwick and Ory (2003), sustainability is understood and approached as the ability to continue the program over time. Understanding factors that influence the sustainability of teams and ways to mitigate these factors is paramount to improving the longevity and quality of service delivery models of this kind. Using qualitative data collected in interviews, the aim of this study is twofold: (1) to explore the factors that affect the sustainability of the teams at three different scales, and; (2) based on the results of this study, to propose a set of recommendations that will contribute to the sustainability of PC teams. Sustainability was conceptualized from two angles: internal and external. An overview of external sustainability was provided and the merging of data from all participant groups showed that the sustainability of teams was largely dependent on actors and organizations at the local (community), regional (Local Health Integration Network or LHIN) and provincial scales. The three scales are not self-contained or singular entities but rather are connected. Integration and collaboration within and between scales is necessary, as community capacity will inevitably reach its threshold without support of the province, which provides funding to the LHIN. While the community continues to advocate for the teams, in the long-term, they will need additional supports from the LHIN and province. The province has the authority and capacity to engrain its support for teams through a formal strategy. The recommendations are presented based on scale to better illustrate how actors and organizations could move forward. This study may inform program and policy specific to strategic ways to improve the provision of team-based palliative home care using a shared care model, while simultaneously providing
Tracy, Jane; McDonald, Rachael
Background: Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving high-quality health care.…
Pons-Vigués, Mariona; Berenguera, Anna; Coma-Auli, Núria; Pombo-Ramos, Haizea; March, Sebastià; Asensio-Martínez, Angela; Moreno-Peral, Patricia; Mora-Simón, Sara; Martínez-Andrés, Maria; Pujol-Ribera, Enriqueta
Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention. A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out. Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having
Port Harcourt. ... Journal of Community Medicine and Primary Health Care. 25 (2) 53-58. KEYWORDS. Healer shopping,. Discharge Against. Medical Advice,. Non- communicable diseases, epidemiological transition, Port.
Sahavechaphan, Naiyana; Phengsuwan, Jedsada; U-Ruekolan, Suriya; Aroonrua, Kamron; Ponhan, Jukrapong; Harnsamut, Nattapon; Vannarat, Sornthep
Heath information across geographically distributed healthcare centers has been recognized as an essential resource that drives an efficient national health-care plan. There is thus a need for the National Health Information System (NHIS) that provides the transparent and secure access to health information from different healthcare centers both on demand and in a time efficient manner. As healthiness is the ultimate goal of people and nation, we believe that the NHIS should be sustainable by taking the healthcare center and information consumer perspectives into account. Several issues in particular must be resolved altogether: (i) the diversity of health information structures among healthcare centers; (ii) the availability of health information sharing from healthcare centers; (iii) the efficient information access to various healthcare centers; and (iv) the privacy and privilege of heath information. To achieve the sustainable NHIS, this paper details our work which is divided into 3 main phases. Essentially, the first phase focuses on the application of metadata standard to enable the interoperability and usability of health information across healthcare centers. The second phase moves forward to make information sharing possible and to provide an efficient information access to a large number of healthcare centers. Finally, in the third phase, the privacy and privilege of health information is promoted with respect to access rights of information consumers.
Taylor, Selina; Fatima, Yaqoot; Lakshman, Navaratnam; Roberts, Helen
The literature on interprofessional learning (IPL) has limited empirical evidence on the impact of simulated IPL sessions in promoting collaborative health care services in rural settings. This study aims to explore health care students' perception of the relevance of simulated IPL for rural health care services. Three focus group interviews were held with pre-registration medical, pharmacy, and allied health students (n=22). Students worked together to manage complex simulation scenarios in small interprofessional teams. Focus group sessions were held at the end of simulation activities to explore students' views on the relevance of simulated IPL activities. Thematic analysis was undertaken on the qualitative data obtained from the focus groups. Participants embraced both the interprofessional and the simulation components enthusiastically and perceived these to be useful for their future as rural health care practitioners. Four major themes emerged from the qualitative analysis: appreciation of the role of other health disciplines, collaborative approach to patient care, competency and skills for future health care practice, and relevance for future rural and remote health care practice. Students acknowledged the simulated IPL sessions for improving their understanding of multidisciplinary practice in rural practice and facilitating the appreciation for collaborative practice and expertise. Based on the findings of this study, simulated IPL activities seem to be a potential intervention for developing collaborative practice among pre-registration health profession students. However, further evidence is required to assess if positive responses to simulated IPL activities are sustained in practice and translate into improving patient outcome.
Taylor, Selina; Fatima, Yaqoot; Lakshman, Navaratnam; Roberts, Helen
Background The literature on interprofessional learning (IPL) has limited empirical evidence on the impact of simulated IPL sessions in promoting collaborative health care services in rural settings. This study aims to explore health care students’ perception of the relevance of simulated IPL for rural health care services. Methods Three focus group interviews were held with pre-registration medical, pharmacy, and allied health students (n=22). Students worked together to manage complex simulation scenarios in small interprofessional teams. Focus group sessions were held at the end of simulation activities to explore students’ views on the relevance of simulated IPL activities. Thematic analysis was undertaken on the qualitative data obtained from the focus groups. Results Participants embraced both the interprofessional and the simulation components enthusiastically and perceived these to be useful for their future as rural health care practitioners. Four major themes emerged from the qualitative analysis: appreciation of the role of other health disciplines, collaborative approach to patient care, competency and skills for future health care practice, and relevance for future rural and remote health care practice. Students acknowledged the simulated IPL sessions for improving their understanding of multidisciplinary practice in rural practice and facilitating the appreciation for collaborative practice and expertise. Conclusion Based on the findings of this study, simulated IPL activities seem to be a potential intervention for developing collaborative practice among pre-registration health profession students. However, further evidence is required to assess if positive responses to simulated IPL activities are sustained in practice and translate into improving patient outcome. PMID:28684916
1Department of Paediatrics and Child Health, Faculty of Clinical Sciences, College of Health Sciences,. Obafemi Awolowo ... Younger parents less than 35years, parents with lower educational attainments and low .... staffing, availability of immunization consumables was estimated using the Computer Programme for.
financing are critical issues that continue to bother health policy makers. .... Ethical approval. Ethical approval was obtained from the. Health Research Ethics Committee of the Delta. State University Teaching Hospital, Oghara and informed written (and or verbal) ... Teachers/Religious Leaders. Indifferent. 85. 24.3%. 117.
Background: Quarry industry has become a major means of livelihood in Ebonyi state, but insufficient data exists on their operations and use of control measures like dust mask, with no serious attempt at comprehensive health education. The study sought to assess the effect of health education on the perception and ...
mania) and anxiety disorders (General anxiety, agoraphobia, social phobia, obsessive-compulsive disorder and post traumatic stress disorder). Conclusion: Findings suggest that there is need to consider mental and psychological care of clients with HIV/AIDS to minimise the prevalence of psychiatric disorder among HIV ...
Methodology. A cross-sectional survey of patients at the antiretroviral clinic of the Federal Medical Centre,. Makurdi, Nigeria, was conducted between June and August 2008. An adapted version of the RAND. Patient Satisfaction Questionnaire Long Form was used to assess seven dimensions of care: general satisfaction ...
Dunlop, D W
The economic realities of health sector development in Africa has been analyzed in this paper. Both the global and national macroeconomic context has been defined. Given the available data, it is clear that most African countries face increasingly serious economic realities, such as slow or even declining economic growth (per capita), a depressed food production situation, severe balance of payments crises, and increasing dependence on external financial assistance. Given the limited but increasingly available 1981 and 1982 data, the economic situation in many countries is more constrained than those indicated by the data contained in this paper. In this context, the potential competitive situation facing governmental health care systems was reviewed. In addition, the diversity in the sources of health expenditures between countries in Africa was highlighted. These data provide clear evidence that governments clearly do not finance the entire health care system and that individual payment for service in many countries represent an important source of revenue for many care providers in various health care systems operating in any given country. The potential for governments to finance either an expansion of or improvements to the government component of their health care systems is then reviewed. The highlights of this analysis include the following points. First, the tax structure in many African countries is highly dependent on export and import duties, which in turn creates dependency on sustained foreign demand for exports.(ABSTRACT TRUNCATED AT 250 WORDS)
Jones, W. L.
Space age health care delivery is being delivered to both NASA astronauts and employees with primary emphasis on preventive medicine. The program relies heavily on comprehensive health physical exams, health education, screening programs and physical fitness programs. Medical data from the program is stored in a computer bank so epidemiological significance can be established and better procedures can be obtained. Besides health care delivery to the NASA population, NASA is working with HEW on a telemedicine project STARPAHC, applying space technology to provide health care delivery to remotely located populations.
Merlino, James I; Raman, Ananth
The Cleveland Clinic has long had a reputation for medical excellence. But in 2009 the CEO acknowledged that patients did not think much of their experience there and decided to act. Since then the Clinic has leaped to the top tier of patient-satisfaction surveys, and it now draws hospital executives from around the world who want to study its practices. The Clinic's journey also holds Lessons for organizations outside health care that must suddenly compete by creating a superior customer experience. The authors, one of whom was critical to steering the hospital's transformation, detail the processes that allowed the Clinic to excel at patient satisfaction without jeopardizing its traditional strengths. Hospital leaders: Publicized the problem internally. Seeing the hospital's dismal service scores shocked employees into recognizing that serious flaws existed. Worked to understand patients' needs. Management commissioned studies to get at the root causes of dissatisfaction. Made everyone a caregiver. An enterprisewide program trained everyone, from physicians to janitors, to put the patient first. Increased employee engagement. The Clinic instituted a "caregiver celebration" program and redoubled other motivational efforts. Established new processes. For example, any patient, for any reason, can now make a same-day appointment with a single call. Set patients' expectations. Printed and online materials educate patients about their stays--before they're admitted. Operating a truly patient-centered organization, the authors conclude, isn't a program; it's a way of life.
Chang, Jason; Mclemore, Elisabeth; Tejirian, Talar
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.
Full Text Available The Family Dental Health Care Service is a new approach that includes efforts to serve oral and dental patients that focuses on maintenance, improvement and protection. This oral and dental health approach uses basic dentistry science and technology. The vision of the Family Dental Health Care Service is the family independences in the effort of dental health maintenance and to achieve the highest oral and dental health degree as possible through family dentist care that is efficient, effective, fair, evenly distributed, safe and has a good quality. To support this effort, the Ministry of Health has issued Health Care Policy and Implementation Guideline as well as the licensing standard for family dentist practice.
McDavid, Lolita M
Children in foster care need more from health providers than routine well-child care. The changes in legislation that were designed to prevent children from languishing in foster care also necessitate a plan that works with the child, the biological family, and the foster family in ensuring the best outcome for the child. This approach acknowledges that most foster children will return to the biological family. Recent research on the effect of adverse childhood experiences across all socioeconomic categories points to the need for specifically designed, focused, and coordinated health and mental health services for children in foster care. Copyright © 2015 Elsevier Inc. All rights reserved.
Nautical tourism is one of the developing branches of tourism in Europe. It differs from other forms of tourism. Conditions under which nautical tourists live are similar to those of seamen employed on vessels in costal shipping. The health care for nautical tourists should be organized according to the principles of health care for crews of merchant ships engaged in constal shipping.
communicable diseases such as hypertension and transitions currently experienced in Sub-Saharan. 96. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 1, MARCH 2014. KEYWORDS journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. Journal of Community Medicine ...
This editorial reviews areas of health care reform including managed health care, diagnosis-related groups, and the Resource-Based Relative Value Scale for physician services. Relevance of such reforms to people with developmental disabilities is considered. Much needed insurance reform is not thought to be likely, however. (DB)
PRIMARY HEALTH CARE. Journal of Community Medicine and Primary Health Care. 26 (1) 21-29. KEYWORDS. Household, expenditure,. Treatment, presumptive malaria,. Gimba ... A cross-sectional descriptive study conducted during community diagnosis posting of final year medical students of. Ahmadu Bello University ...
Beatty, Rebecca M.
Survey responses from 71 health professionals, benchmarking data from 8 hospitals, continuing education program evaluations, and focus groups with nursing, allied health, and primary care providers indicated a need for professional continuing education on women's health issues. Primary topic needs were identified. The data formed the basis for…
Miles, Stephen H.; And Others
A discussion of the role of academic health centers in health care reform efforts looks at the following issues: balancing academic objectivity and social advocacy; managing sometimes divergent interests of centers, faculty, and society; and the challenge to develop infrastructure support for reform. Academic health centers' participation in…
National Assembly on School-Based Health Care, 2012
The National Assembly on School-Based Health Care (NASBHC) surveys state public health and Medicaid offices every three years to assess state-level public policies and activities that promote the growth and sustainability of school-based health services. The FY2011 survey found 18 states (see map below) reporting investments explicitly dedicated…
May 1, 2012 ... Results: The findings reveal different modes money was made available for payment for health services. On the whole, about 98% of payment was through out-of pocket spending (user-charges) with most respondents using their own money. Although this financing method shown to be associated with ...
2Department of Community Health, University of Benin Teaching Hospital, Benin City, Edo State. 1. 2. 2. Awunor N.S , Omuemu V.O , Adam V.Y. ABSTRACT. Introduction. A nation's disease control effort is often as good as the surveillance and notification system put in place, which would help to generate the much needed ...
living on each square inch of the phone. This study determined the prevalence of micro-organisms on the mobile phones of health workers and their role as a source of hospital acquired infection. The study utilised a cross-sectional design. A total of one hundred and eighty swabs were collected from the mobile phones of ...
child deaths among under-fives were due to. Childhood immunization is an effective public. VPDs, this represents 17% of global total. 1 health initiative aimed at reducing the burden mortality in children under five years of age. of vaccine preventable diseases (VPDs) and. To achieve the Millennium Developmental.
Oct 7, 2011 ... These factors include poor environmental and personal hygiene, poverty, malnutrition, unsafe water supply and ... The environment farmers live in, their standard of living and nutrition are very important to their health. ..... Globalization of food system: JOURNAL OF COMMUNITY MEDICINE AND PRIMARY ...
instruments were pretested self-administered questionnaire and observational checklist. The data generated were analyzed using .... The observational checklist (OBL) was used to. Kwara State was carried from April to ..... supervision of health workers by middle cadre Central Zonal Office). Report on Routine immunization ...
Further studies on this subject are recommended. Employees' Assessment of Leadership in a Tertiary. Hospital in South-South Nigeria. Adeleye O. A, Aduh U. Department of Community Health, .... National Institute of Standards and Technology, (where it is trying to go in the future)”; “my senior were originally designed for ...
Rafiei, Masoud; Ezzatian, Reza; Farshad, Asghar; Sokooti, Maryam; Tabibi, Ramin; Colosio, Claudio
A healthy workforce is vital for maintaining social and economic development on a global, national and local level. Around half of the world's people are economically active and spend at least one third of their time in their place of work while only 15% of workers have access to basic occupational health services. According to WHO report, since the early 1980s, health indicators in Iran have consistently improved, to the extent that it is comparable with those in developed countries. In this paper it was tried to briefly describe about Health care system and occupational Health Services as part of Primary Health care in Iran. To describe the health care system in the country and the status of occupational health services to the workers and employers, its integration into Primary Health Care (PHC) and outlining the challenges in provision of occupational health services to the all working population. Iran has fairly good health indicators. More than 85 percent of the population in rural and deprived regions, for instance, have access to primary healthcare services. The PHC centers provide essential healthcare and public-health services for the community. Providing, maintaining and improving of the workers' health are the main goals of occupational health services in Iran that are presented by different approaches and mostly through Workers' Houses in the PHC system. Iran has developed an extensive network of PHC facilities with good coverage in most rural areas, but there are still few remote areas that might suffer from inadequate services. It seems that there is still no transparent policy to collaborate with the private sector, train managers or provide a sustainable mechanism for improving the quality of services. Finally, strengthening national policies for health at work, promotion of healthy work and work environment, sharing healthy work practices, developing updated training curricula to improve human resource knowledge including occupational health
Leanza, Francesco; Hauser, Diane
Teens are avid users of new technologies and social media. Nearly 95% of US adolescents are online at least occasionally. Health care professionals and organizations that work with teens should identify online health information that is both accurate and teen friendly. Early studies indicate that some of the new health technology tools are acceptable to teens, particularly texting, computer-based psychosocial screening, and online interventions. Technology is being used to provide sexual health education, medication reminders for contraception, and information on locally available health care services. This article reviews early and emerging studies of technology use to promote teen health. Copyright © 2014 Elsevier Inc. All rights reserved.
Takian, Amirhossein; Akbari-Sari, Ali
Sustainable Development Goals (SDGs) aim to transform our world, and each goal has specific targets to be achieved by 2030. For the goals to be achieved, everyone needs to do their part: governments, academia, the private sector and all people. This paper summarizes the main evidence-based recommendations made by excellent academics and scholars who discussed their experiences and views during the conference to respond to the challenges of sustainable health development. To contribute to exploring to the academia's role in reaching SDGs, the 1(st) International Conference on Sustainable Health Development was held at Tehran University of Medical Sciences, on 24-25 April 2016, in Tehran, Iran. In line with Goal 3 of SDGs: "ensure healthy lives and promote well-being for all at all ages", the conference discussed various aspects of Universal Health Coverage (UHC), as well as Global Action Plans for prevention and control of Non-Communicable Diseases (NCDs), and explained the special role of academic public health institutes in education, research and service provision in the two above-mentioned areas. To fulfill the requirements of SDGs, modern approaches to funding, education, teaching, research priority setting and advocacy, which in turn need novel strategies in collaboration and constructive partnerships among academic public health institutes from low, middle and high-income countries, are essential.
Miles, S H; Lurie, N; Fisher, E S; Haugen, D
There is increasing support for the proposition that academic health centers have a duty to accept broad responsibility for the health of their communities. The Health of the Public program has proposed that centers become directly involved in the social-political process as advocates for reform of the health care system. Such engagement raises important issues about the roles and responsibilities of centers and their faculties. To address these issues, the authors draw upon the available literature and their experiences in recent health care reform efforts in Minnesota and Vermont in which academic health center faculty participated. The authors discuss (1) the problematic balance between academic objectivity and social advocacy that faculty must attempt when they engage in the health care reform process; (2) the management of the sometimes divergent interests of academic health centers, some of their faculty, and society (including giving faculty permission to engage in reform efforts and developing a tacit understanding that distinguishes faculty positions on reform issues from the center's position on such issues); and (3) the challenge for centers to develop infrastructure support for health reform activities. The authors maintain that academic health centers' participation in the process of health care reform helps them fulfill the trust of the public that they are obligated to and ultimately depend on.
Adil, M M; Larriviere, D
Approximately 20% of all deaths in the USA occur in the intensive care unit (ICU) and the majority of ICU deaths involves decision of de-escalation of life-sustaining interventions. Life-sustaining interventions may include intubation and mechanical ventilation, artificial nutrition and hydration, antibiotic treatment, brain surgery, or vasoactive support. Decision making about goals of care can be defined as an end-of-life communication and the decision-making process between a clinician and a patient (or a surrogate decision maker if the patient is incapable) in an institutional setting to establish a plan of care. This process includes deciding whether to use life-sustaining treatments. Therefore, family discussion is a critical element in the decision-making process throughout the patient's stay in the neurocritical care unit. A large part of care in the neurosciences intensive care unit is discussion of proportionality of care. This chapter provides a stepwise approach to hold these conferences and discusses ways to do it effectively. © 2017 Elsevier B.V. All rights reserved.
Full Text Available Abstract Background Developments in information technology promise to revolutionise the delivery of health care by providing access to data in a timely and efficient way. Information technology also raises several important concerns about the confidentiality and privacy of health data. New and existing legislation in Europe and North America may make access to patient level data difficult with consequent impact on research and health surveillance. Although research is being conducted on technical solutions to protect the privacy of personal health information, there is very little research on ways to improve individuals power over their health information. This paper proposes a health care information directive, analogous to an advance directive, to facilitate choices regarding health information disclosure. Results and Discussion A health care information directive is described which creates a decision matrix that combines the ethical appropriateness of the use of personal health information with the sensitivity of the data. It creates a range of possibilities with in which individuals can choose to contribute health information with or without consent, or not to contribute information at all. Conclusion The health care information directive may increase individuals understanding of the uses of health information and increase their willingness to contribute certain kinds of health information. Further refinement and evaluation of the directive is required.
health care and reproductive health. It plays a major role in reducing maternal and neonatal morbidity. Access to family planning also has the and mortality. It confers important health and potential to control population growth and in the development benefits to individuals, families, long run reduce green house gas emission ...
activities in the health centres ( Table 2) The study showed that community health extension workers were responsible for ... development goals for mothers and children as distant as it was 40 years ago when primary health care strategy was adopted for ... Most of them were very experienced, 50% of. The study (Table II) ...
Full Text Available The paper deals with conscientious objection in health care, addressing the problems of scope, verification and limitation of such refusal, paying attention to ideological agendas hidden behind the right of conscience where the claimed refusal can cause harm or where such a claim is an attempt to impose certain moral values on society or an excuse for not providing health care. The nature of conscientious objection will be investigated and an ethical analysis of conscientious objection will be conducted. Finally some suggestions for health care policy will be proposed.
U.S. Department of Health & Human Services — A list of all Home Health Agencies that have been registered with Medicare. The list includes addresses, phone numbers, and quality measure ratings for each agency.
... Sloane PD, Warshaw GA, et al, eds. Ham's Primary Care Geriatrics: A Case-Based Approach . 6th ed. ... Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, ...
Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost
Canavan, Chelsey R; Noor, Ramadhani A; Golden, Christopher D; Juma, Calestous; Fawzi, Wafaie
Sustainable food systems are an important component of a planetary health strategy to reduce the threat of infectious disease, minimize environmental footprint and promote nutrition. Human population trends and dietary transition have led to growing demand for food and increasing production and consumption of meat, amid declining availability of arable land and water. The intensification of livestock production has serious environmental and infectious disease impacts. Land clearing for agriculture alters ecosystems, increases human-wildlife interactions and leads to disease proliferation. Context-specific interventions should be evaluated towards optimizing nutrition resilience, minimizing environmental footprint and reducing animal and human disease risk. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
Campbell, Robert James
This article introduces health care managers to the theories and philosophies of John Kotter and William Bridges, 2 leaders in the evolving field of change management. For Kotter, change has both an emotional and situational component, and methods for managing each are expressed in his 8-step model (developing urgency, building a guiding team, creating a vision, communicating for buy-in, enabling action, creating short-term wins, don't let up, and making it stick). Bridges deals with change at a more granular, individual level, suggesting that change within a health care organization means that individuals must transition from one identity to a new identity when they are involved in a process of change. According to Bridges, transitions occur in 3 steps: endings, the neutral zone, and beginnings. The major steps and important concepts within the models of each are addressed, and examples are provided to demonstrate how health care managers can actualize the models within their health care organizations.
JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 26, NO 1, MARCH 2014. INTRODUCTION disability from complications of pregnancy and. 1 child birth. MI in birth preparedness is. Birth preparedness by a couple ensures that indispensible in rural communities where patriarchy appropriate care ...
Jonsson, E.; Banta, H.D.
Health care in Sweden is a public sector responsibility and equity in access to care is quite important. The Swedish system is organized into several levels, with the Federation of County Councils at the top, and with regional, county, and local levels. In theory, the four hospital tiers developed
Sherertz, R J; Bassetti, S.; Bassetti-Wyss, B.
Certain bacteria dispersed by health-care workers can cause hospital infections. Asymptomatic health-care workers colonized rectally, vaginally, or on the skin with group A streptococci have caused outbreaks of surgical site infection by airborne dispersal. Outbreaks have been associated with skin colonization or viral upper respiratory tract infection in a phenomenon of airborne dispersal of Staphylococcus aureus called the "cloud" phenomenon. This review summarizes the data supporting the e...
Marasović Šušnjara, Ivana
Corruption is a global problem that takes special place in health care system. A large number of participants in the health care system and numerous interactions among them provide an opportunity for various forms of corruption, be it bribery, theft, bureaucratic corruption or incorrect information. Even though it is difficult to measure the amount of corruption in medicine, there are tools that allow forming of the frames for possible interventions.
Simms, Mark D.; Freundlich, Madelyn; Battistelli, Ellen S.; Kaufman, Neal D.
Describes the essential features of a health care system that can meet the special needs of children in out-of-home care. Discusses some of the major recent changes brought about by welfare and health care reform. Notes that it remains to be seen whether the quality of services will improve as a result of these reforms. (Author)
Pesec, Madeline; Ratcliffe, Hannah L; Karlage, Ami; Hirschhorn, Lisa R; Gawande, Atul; Bitton, Asaf
Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica's innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica's experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented. Project HOPE—The People-to-People Health Foundation, Inc.
... Control Preventing infections can help the respiratory home care patient stay as healthy as possible. Hand-washing is the single most important thing for patients and caregivers to perform on a routine basis. Use a liquid soap and lots of warm running water. Work up a good lather and scrub for at ...
Grazier, Kyle L; Metzler, Bridget
Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects.
links with goal 3 of the sustainable development goals that focus on ensuring healthy lives and promoting well-being at ... among Primary Health Care (PHC) nurses could have a negative effect on the achievement of high standards in health ... The accessible population in this study was PHC nurses. (N ¼ 30) working at 13 ...
... in medical offices or in the dialysis unit. Nephrology Nurse Nephrology nurses are licensed, registered nurses who ... nutritional intake to ensure the patient's optimal health. Nephrology Social Worker Most nephrology social workers have a ...
Buchanan, Larry M.
It is widely recognized throughout the health care industry that the United States leads the world in health care spending per capita. However, the chilling dose of reality for American health care consumers is that for all of their spending, the World Health Organization ranks the country's health care system 37th in overall performance--right…
... Living Listen Español Text Size Email Print Share Mental Health Care: Who's Who Page Content Article Body Psychiatrist: ... degree in psychology, counseling or a related field. Mental Health Counselor: Master’s degree and several years of supervised ...
the children didnot receive BCG vaccine while spiritual homes was the pattern in 6.9 households. 22.9% did not receive measles vaccine. A total of 63 under-five deaths were reported in 53. Table VI shows the health-seeking behaviour of. 6. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL.
This podcast will educate health care providers on diagnosing babesiosis and providing patients at risk with tick bite prevention messages. Created: 4/25/2012 by Center for Global Health, Division of Parasitic Diseases and Malaria. Date Released: 4/25/2012.
Full Text Available Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.
Previously, the main focus of primary health care practices was to diagnose and treat patients. The identification of risk factors for disease and the prevention of chronic conditions have become a part of everyday practice. This paper provides an argument for training primary health care (PHC) practitioners in health promotion, while encouraging them to embrace innovation within their practice to streamline the treatment process and improve patient outcomes. Electronic modes of communication, education and training are now commonplace in many medical practices. The PHC sector has a small window of opportunity in which to become leaders within the current model of continuity of care by establishing their role as innovators in the prevention, treatment and management of disease. Not only will this make their own jobs easier, it has the potential to significantly impact patient outcomes.
Svendsen, Gunnar Lind Haase; Jensen, Marit Vatn
This literature study focuses on possible links between access to health services and migration in rural areas. Why do people move to or from rural areas or why do they stay? What determines where people settle? And, in this context, do local health care services play an important or minor role......, or no role at all? First, the paper reports on key findings from rural migration studies, in order to shed light on two migration trends: urbanization and counter-urbanization. Then we take a closer look on settlement preferences in rural areas, including the impact of health care facilities. Finally, we end...
Kutcher, Stan; Chehil, Sonia; Roberts, Thorne
... & evidenced-based treatment of mental disorders occurring after a natural disaster. The approach also provided for ongoing, sustainable mental health care delivered in the community setting, as advocated by the World Health Organization...
Norr, Kathleen F.; McElmurry, Beverly J.; Slutas, Frances M.; Christiansen, Carol D.; Misner, Susan J.; Marks, Beth A.
Using primary health care and peer leadership models, U.S. nurses trained Lithuanian health professionals as community peer leaders in AIDS prevention. A national continuing education program is in place to sustain the initiative in Lithuania. (SK)
Full Text Available This article explores the notion of ecological sustainability in the context of public health education and the contribution Universities can make in creating environments that include ecologically sustainable practices. It considers the important role of environmental health in building a sustainable future for the population as a central plank of public health. It presents the evidence for the need for comprehensive approaches to ecological sustainability within the University and offers suggestions about how this can take place. It concludes by arguing that to date there is a substantial gap between the rhetoric and the reality in the University context.
Background An integrated chronic disease management (ICDM) model consisting of four components (facility reorganisation, clinical supportive management, assisted self-supportive management and strengthening of support systems and structures outside the facility) has been implemented across 42 primary health care clinics in South Africa with a view to improve the operational efficiency and patient clinical outcomes. Aim The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation. Setting The study was conducted at 37 of the initiating clinics across three districts in three provinces of South Africa. Methods The National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model (SM) self-assessment tool was used to assess sustainability. Results Bushbuckridge had the highest mean sustainability score of 71.79 (95% CI: 63.70–79.89) followed by West Rand Health District (70.25 (95% CI: 63.96–76.53)) and Dr Kenneth Kaunda District (66.50 (95% CI: 55.17–77.83)). Four facilities (11%) had an overall sustainability score of less than 55. Conclusion The less than optimal involvement of clinical leadership (doctors), negative staff behaviour towards the ICDM, adaptability or flexibility of the model to adapt to external factors and infrastructure limitation have the potential to negatively affect the sustainability and scale-up of the model. PMID:28155314
Mahomed, Ozayr H; Asmall, Shaidah; Voce, Anna
An integrated chronic disease management (ICDM) model consisting of four components (facility reorganisation, clinical supportive management, assisted self-supportive management and strengthening of support systems and structures outside the facility) has been implemented across 42 primary health care clinics in South Africa with a view to improve the operational efficiency and patient clinical outcomes. The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation. The study was conducted at 37 of the initiating clinics across three districts in three provinces of South Africa. The National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model (SM) self-assessment tool was used to assess sustainability. Bushbuckridge had the highest mean sustainability score of 71.79 (95% CI: 63.70-79.89) followed by West Rand Health District (70.25 (95% CI: 63.96-76.53)) and Dr Kenneth Kaunda District (66.50 (95% CI: 55.17-77.83)). Four facilities (11%) had an overall sustainability score of less than 55. The less than optimal involvement of clinical leadership (doctors), negative staff behaviour towards the ICDM, adaptability or flexibility of the model to adapt to external factors and infrastructure limitation have the potential to negatively affect the sustainability and scale-up of the model.
Aydin, Mehmet Cihan; IŞIK, Ercan; Ulu, Ali Emre
Sustainable development aims to bring a new perspective to our lives without compromising customer needs and quality. Along with sustainable development many innovative solutions came out. One of them is sustainable green cleaning products and techniques. Today, emissions from conventional cleaning products may cause severe health and environmental issues. Especially sick building syndromes such as eye, skin and respiratory irritations are main health effects of them. They may also contrib...
Patrick, Rebecca; Kingsley, Jonathan
Issue addressed Health promotion practitioners have important roles in applying ecosystem approaches to health and actively promoting environmental sustainability within community-level practice. The present study identified the nature and scope of health promotion activities across Australia that tackle environmental sustainability. Methods A mixed-method approach was used, with 82 participants undertaking a quantitative survey and 11 undertaking a qualitative interview. Purposeful sampling strategies were used to recruit practitioners who were delivering community-level health promotion and sustainability programs in Australia. The data were analysed thematically and interpretation was guided by the principles of triangulation. Results Study participants were at various stages of linking health promotion and environmental sustainability. Initiatives focused on healthy and sustainable food, active transport, energy efficiency, contact with nature and capacity building. Conclusion Capacity building approaches were perceived as essential to strengthening this field of practice. Healthy and sustainable food and active transport were suitable platforms for simultaneously promoting community health and sustainability. There was potential for expansion of programs that emphasise contact with nature and energy issues, as well as interventions that emphasise systems thinking and interdisciplinary approaches. So what? It was promising that Australian health promotion programs have started to address complexity rather than single issues, as evidenced by explicit engagement with environmental sustainability. However, more effort is required to enable a shift towards ecosystem approaches to health.
Background: Primary health care involves a sustained partnership between patients and providers that addresses the majority of a population's health needs over time. Patients' perception of satisfaction is an aspect of healthcare quality that is being increasingly recognised for its importance. The objective of this study was ...
National Environmental Education & Training Foundation, 2012
This document lays out the strategy for achieving the goals and objectives of NEETF's "Health Care Provider Initiative." The goal of NEETF's "Health Care Provider Initiative" is to incorporate environmental health into health professionals' education and practice in order to improve health care and public health, with a special emphasis on…
Araújo, Patricia Sodré; Costa, Ediná Alves; Guerra, Augusto Afonso; Acurcio, Francisco de Assis; Guibu, Ione Aquemi; Álvares, Juliana; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair
To characterize the activities of clinical nature developed by pharmacists in basic health units and their participation in educational activities aiming at health promotion. This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional and exploratory study, of evaluative nature, consisting of a survey of information in a representative sample of cities, stratified by the Brazilian regions that constitute domains of study, and a subsample of primary health care services. The interviewed pharmacists (n=285) were responsible for the delivery of medicines and were interviewed in person with the use of a script. The characterization of the activities of clinical nature was based on information from pharmacists who declared to perform them, and on participation in educational activities aiming at health promotion, according to information from all pharmacists. The results are presented in frequency and their 95% confidence intervals. From the interviewed subjects, 21.3% said they perform activities of clinical nature. Of these, more than 80% considered them very important; the majority does not dispose of specific places to perform them, which hinders privacy and confidentiality in these activities. The main denominations were "pharmaceutical guidance" and "pharmaceutical care." The registration of activities is mainly made in the users' medical records, computerized system, and in a specific document filed at the pharmacy, impairing the circulation of information among professionals. Most pharmacists performed these activities mainly along with physicians and nurses; 24.7% rarely participated in meetings with the health team, and 19.7% have never participated. Activities of clinical nature performed by pharmacists in Brazil are still incipient. The difficulties found point out
Halfon, Neal; And Others
Outlines access to health care for children in out-of-home care under current law, reviews how health care access for these children would be affected by President Clinton's health care reform initiative, and proposes additional measures that could be considered to improve access and service coordination for children in the child welfare system.…
Madsen, Katrine Dahl; Nordin, Lone Lindegaard; Simovska, Venka
This chapter addresses the relationship between international and national policies regarding sustainability and health promotion which have the potential to affect school-based health education/promotion and education for sustainable development in Denmark. Based on policy mapping and analysis...... education in Denmark with its aims of ensuring overall school improvement, increasing pupil wellbeing and improving academic outcomes. Analysis of international policy documents, as well as of research literature shows that school-based health education (HE) and education for sustainable development (ESD...... on the common tendency that when health and sustainability education in schools are framed in national action plans, certain critical educational aspects are lost by narrowing the concepts of health and sustainability to fit particular school subjects (e.g. physical education or science), and defining outcomes...
Hearld, Larry R; Bleser, William K; Alexander, Jeffrey A; Wolf, Laura J
Recent interest in community health collaboratives has been driven by the potential of these types of organizations to solve complex health problems at the local level by bringing together stakeholders that have traditionally operated independently, and often at cross-purposes. Much of the work that is central to the mission of collaboratives can take years to reach fruition, however, and there are a number of challenges to sustaining their activities. In this article, we systematically reviewed the theoretical and empirical literature on health care collaborative sustainability, focusing on definitions and antecedents of sustainability. Given the diversity and fragmentation of this literature, we used this review as a foundation to develop a synthesized definition, conceptual groups of antecedents, and potential research propositions to help guide future research, planning, and practice of sustainable community health collaboratives. © The Author(s) 2015.
Young, D W
Many Western European countries are moving toward privatization of their health care systems. The United States' health care system, since it is almost entirely privatized, is therefore worthy of study. Doing so raises several questions. How is privatization being managed in the US? How could its management be improved? What management lessons must be kept in mind if it is to be used effectively? What potential pitfalls should European countries consider as they move toward greater privatization? With operating costs, European countries must avoid the mistakes that have led to dramatic increases in annual health care costs in the US, simultaneous with reductions in access and quality. Doing so requires designing systems that promote hospital behavior consistent with a country's health objectives. With capital costs, an approach must be designed that allows policy-makers to work closely with both managers and physicians in order to make strategically sound choices about access and quality. Such an approach will require physicians to incorporate their clinical judgments into community standards of care, and to adopt a regional (rather than an institutional or personal) perspective in the determination of any incremental capital expenditures. By making regulation proactive and strategic, rather than punitive, health policymakers in Western Europe can achieve the best privatization has to offer without feeling the sting of its unintended consequences. In so doing they can help to move their health systems toward achieving the multiple and illusive goals of access, quality and reasonable cost.
Jelsøe, Erling; Thualagant, Nicole; Holm, Jesper
. Despite obvious interfaces and interactions between the two, our contention is that strategies for health promotion are not sufficiently integrated with strategies for sustainable development and that policies aimed at solving health or sustainability problems may therefore cause new, undesired...
telemonitoring . In emergency cases where immediate medical treatment is the issue, recent studies conclude that early and specialized pre-hospital patient ...Lama, J Vila: “Intelligent Telemonitoring of Critical Care Patients ”, IEEE EMB Mag, Vol 18, No 4, pp 80-88, Jul/Aug 1999.  Strode S, Gustke S...Abstract- In this study we present a multipurpose health care telemedicine system, which can be used for emergency or patient monitoring cases
This article discusses considerations for making ambulatory care pharmacist services at least cost neutral and, ideally, generate a margin that allows for service expansion. The four pillars of business sustainability are leadership, staffing, information technology, and compensation. A key facet of leadership in ambulatory care pharmacy practice is creating and expressing a clear vision for pharmacists' services. Staffing considerations include establishing training needs, maximizing efficiencies, and minimizing costs. Information technology is essential for efficiency in patient care delivery and outcomes assessment. The three domains of compensation are cost savings, pay for performance, and revenue generation. The following eight steps for designing and implementing an ambulatory care pharmacist service are discussed: (1) prepare a needs assessment, (2) analyze existing strengths, weaknesses, opportunities, and threats, (3) analyze service gaps and feasibility, (4) consider financial opportunities, (5) consider stakeholders' interests, (6) develop a business plan, (7) implement the service, and (8) measure outcomes. Potential future changes in national healthcare policy (such as pharmacist provider status and expanded pay for performance) could enhance the opportunities for sustainable ambulatory care pharmacy practice. The key challenges facing ambulatory care pharmacists are developing sustainable business models, determining which services yield a positive return on investment, and demanding payment for value-added services. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
Full Text Available This special issue ‘Sustainability: Environmental Studies and Public Health’ is part of the internationally leading 'International Journal of Environmental Research and Public Health’. I was invited to be the guest editor, and to oversee the refereeing process and subsequent selection of timely, relevant and high quality papers highlighting particularly novel aspects concerned with sustainability issues in environmental studies. [...
This podcast is based on the November, 2010 CDC Vital Signs report which indicates that more than one in four adults 18-64 years old (about 50 million) report being uninsured for at least part of the past 12 months, and focuses on the growing number of middle-income adults and those with a chronic illness or disability who have no health insurance. Created: 11/9/2010 by Centers for Disease Control and Prevention (CDC). Date Released: 11/9/2010.
Sahoo, Sanjeeb K
Nanomedicine: Emerging Field of Nanotechnology to Human HealthNanomedicines: Impacts in Ocular Delivery and TargetingImmuno-Nanosystems to CNS Pathologies: State of the Art PEGylated Zinc Protoporphyrin: A Micelle-Forming Polymeric Drug for Cancer TherapyORMOSIL Nanoparticles: Nanomedicine Approach for Drug/Gene Delivery to the BrainMagnetic Nanoparticles: A Versatile System for Therapeutic and Imaging SystemNanobiotechnology: A New Generation of Biomedicine Application of Nanotechnology-Based Drug Delivery and Targeting to LungsAptamers and Nanomedicine in C
The health promotion discourse is comprised of assumptions about health and health care that are compatible with primary health care. An examination of the health promotion discourse illustrates how assumptions of health can help to inform primary health care. Despite health promotion being a good fit for primary health care, this analysis demonstrates that the scope in which it is being implemented in primary health care settings is limited. The health promotion discourse appears largely compatible with primary health care-in theory and in the health care practices that follow. The aim of this article is to contribute to the advancement of theoretical understanding of the health promotion discourse, and the relevance of health promotion to primary health care.
... Management Education & Events Advocacy For Patients About ACOG Good Health Before Pregnancy: Preconception Care Home For Patients Search ... Pregnancy: Preconception Care FAQ056, April 2017 PDF Format Good Health Before Pregnancy: Preconception Care Pregnancy What is a ...
Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special ... for and what to ask will help you choose an organization that provides safe, quality care, treatment ...
Pfaff, H; Pförtner, T-K
Social inequalities in health and health care services represent issues of major concern. Findings in this area reveal inequalities in health and health care indicating disadvantages for individuals with a low socioeconomic background. Although the health care system plays a marginal role in the explanation of inequalities in health, health services research can be an important part in the development of equal health opportunities. The current article describes the causal associations between social inequalities, health inequalities and the health care service. Health services research can make a contribution to increasing equal opportunities in health and health care service. Against this background, we discuss the existing potential and need of research in the area of health services. © Georg Thieme Verlag KG Stuttgart · New York.
Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio
OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949
Heller, Kathryn Wolff; Avant, Mary Jane Thompson
Teachers need to maintain a safe, healthy environment for all their students in order to promote learning. However, there are additional considerations when students require health care procedures, such as tube feeding or clean intermittent catheterization. Teachers must effectively monitor their students and understand their roles and…
This is an empirical study of 7 communities among the O-kun Yoruba of Ijumu, Kogi State, Nigeria. The general objective of the study was to investigate the prioritizing pattern of the various Primary Health Care services (PHC) in the study area. Data for the study were generated mainly through multi-stage sampling ...
Johnson, Claire; Rubinstein, Sidney M; Côté, Pierre
The purpose of this collaborative summary is to document current chiropractic involvement in the public health movement, reflect on social ecological levels of influence as a profession, and summarize the relationship of chiropractic to the current public health topics of: safety, health issues...... through the lifespan, and effective participation in community health issues. The questions that are addressed include: Is spinal manipulative therapy for neck and low-back pain a public health problem? What is the role of chiropractic care in prevention or reduction of musculoskeletal injuries...... of prevention and public health? What role do citizen-doctors of chiropractic have in organizing community action on health-related matters? How can our future chiropractic graduates become socially responsible agents of change?...
Schell, Sarah F; Luke, Douglas A; Schooley, Michael W; Elliott, Michael B; Herbers, Stephanie H; Mueller, Nancy B; Bunger, Alicia C
Public health programs can only deliver benefits if they are able to sustain activities over time. There is a broad literature on program sustainability in public health, but it is fragmented and there is a lack of consensus on core constructs. The purpose of this paper is to present a new conceptual framework for program sustainability in public health. This developmental study uses a comprehensive literature review, input from an expert panel, and the results of concept-mapping to identify the core domains of a conceptual framework for public health program capacity for sustainability. The concept-mapping process included three types of participants (scientists, funders, and practitioners) from several public health areas (e.g., tobacco control, heart disease and stroke, physical activity and nutrition, and injury prevention). The literature review identified 85 relevant studies focusing on program sustainability in public health. Most of the papers described empirical studies of prevention-oriented programs aimed at the community level. The concept-mapping process identified nine core domains that affect a program's capacity for sustainability: Political Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Public Health Impacts, and Strategic Planning. Concept-mapping participants further identified 93 items across these domains that have strong face validity-89% of the individual items composing the framework had specific support in the sustainability literature. The sustainability framework presented here suggests that a number of selected factors may be related to a program's ability to sustain its activities and benefits over time. These factors have been discussed in the literature, but this framework synthesizes and combines the factors and suggests how they may be interrelated with one another. The framework presents domains for public health decision makers to consider when developing
Global warming and environmentalism continue to be national and international issues as their complexities and implications become better understood. One ironic contributor to the degradation of the environment is the health care system. Serving as clinical laboratories, hotels, restaurants, and offices that never close, U.S. hospitals produce more than 2 million tons of waste annually. Although the consequences and significance of health care's carbon footprint are undeniable, strategies to reduce this impact are challenging. This article discusses how the role, traits, and knowledge of nurses combined with their positions in the health care system make them key players in creating an environmentally sustainable health care industry. With an analysis of environmental action versus inaction, this article explores how nurses at the forefront of health care are equipped to change practice that will reach far beyond the bedside.
Iranmanesh, Mohammad; Zailani, Suhaiza; Nikbin, Davoud
Radio-frequency identification (RFID) has been proved to be an effective tool both for improving operational efficiency and for gaining competitive advantage in the health care industry despite its relatively low-usage rate in hospitals. The sustained use of RFID by health care professionals will promote its development in the long term. This study evaluates the acceptance continuance of RFID among health care professionals through technology continuance theory (TCT). Data were collected from 178 medical professionals in Malaysia and were then analyzed using the partial least squares technique. The analysis showed that the TCT model provided not only a thorough understanding of the continuance behavior of health care professionals toward RFID but also the attitudes, satisfaction, and perceived usefulness of professionals toward it. The results of this study are expected to assist policy makers and managers in the health care industry in implementing the RFID technology in hospitals by understanding the determinants of continuance of RFID usage intention.
Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey
The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the
Addresses the crisis in health care, considering costs, lack of access, and system ineffectiveness. Reviews "Setting Relationships Right," the Catholic Health Association's proposal for health care reform. Advocates educators' awareness of children's health needs and health care reform issues and support for the Every Fifth Child Act of…
Le Var, Rita M. H.
Nurses and health care professionals must be prepared for transcultural health care because society is becoming increasingly multicultural and current health services are not meeting the needs of minority ethnic groups in Britain. (SK)
Kepros John P
Full Text Available Abstract Background The health care delivery system in the United States is facing cost and quality pressures that will require fundamental changes to remain viable. The optimal structures of the relationships between the hospital, medical school, and physicians have not been determined but are likely to have a large impact on the future of healthcare delivery. Because it is generally agreed that academic medical centers will play a role in the sustainability of this future system, a fundamental understanding of the relative contributions of the stakeholders is important as well as creativity in developing novel strategies to achieve a shared vision. Discussion Core competencies of each of the stakeholders (the hospital, the medical school and the physicians must complement the others and should act synergistically. At the same time, the stakeholders should determine the common core values and should be able to make a meaningful contribution to the delivery of health care. Summary Health care needs to achieve higher quality and lower cost. Therefore, in order for physicians, medical schools, and hospitals to serve the needs of society in a gratifying way, there will need to be change. There needs to be more scientific and social advances. It is obvious that there is a real and urgent need for relationship building among the professionals whose duty it is to provide these services.
Stimpson, Jim P; Li, Tao; Shiyanbola, Oyewale O; Jacobson, Janelle J
Academic health centers (AHCs) play a vital role in the health care system. The training of health care personnel and delivery of health care services, especially to the most complex and financially challenged patients, has been a responsibility increasingly shouldered by AHCs over the years. Additionally, AHCs play a significant role in researching and developing new treatment protocols, including discovering and validating new health technologies. However, AHCs face unique financial challenges in fulfilling their social mission in the health care system. Reforms being implemented under the Affordable Care Act and shifting economic patterns are threatening the financial sustainability of AHCs.The authors review challenges facing AHCs, including training new health care professionals with fewer funding resources, disproportionate clinical care of complex and costly patients, charity care to uninsured and underinsured, and reduced research funding opportunities. Then, they provide a review of some potential solutions to these challenges, including new reimbursement methods, improvements in operational efficiency, price regulation, subsidization of education, improved decision making and communication, utilization of industrial management tools, and increasing internal and external cooperation. Devising solutions to the evolving problems of AHCs is crucial to improving health care delivery in the United States. Most likely, a combination of market, government, and system reforms will be needed to improve the viability of AHCs and assist them in fulfilling their social and organizational missions.
William D. Nordhaus
National health care goals generally include providing broad access to appropriate amounts of high-quality health care at appropriate cost to the ultimate payers. Yet all countries, regardless of how they deliver and finance health care, struggle to achieve a sustainable balance among the implicit tradeoffs. Does this struggle stem from the limited scope for competition in health care or from information asymmetries? Or does it simply reflect the inherent difficulty of measuring health care o...
Willberg, A; Heger, R
This paper reports in detail on a project of Integrated Health Care in cardiology at Potsdam, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.
Wagner, H C; Fleming, D; Mangold, W G; LaForge, R W
Building relationships with patients is critical to the success of many health care organizations. The authors profile the relationship marketing program for a hospital's cardiac center and discuss the key strategic aspects that account for its success: a focus on a specific hospital service, an integrated marketing communication strategy, a specially designed database, and the continuous tracking of results.
Centres in Sabon Gari Local Government Area, Kaduna State Nigeria. journal of. COMMUNITY MEDICINE. & PRIMARY HEALTH CARE. 1. 1. 1. M.B Sufiyan , A.A Umar , A. Shugaba . 1Department of Community Medicine, Ahmadu Bello University, Zaria. KEYWORDS. Assessment,. Client satisfaction, ANC,. PHC centers.
Handelsman, L; Speiser, M; Maltz, A; Kirpalani, S
Bankruptcy is an event that is often considered a business' worst nightmare. Debt, lawyers, and the U.S. government can lead to the eventual destruction of a business. This article shows how declaring bankruptcy can be a helpful instrument in continuing a successful venture in the health care marketplace.
Hougaard, Jens Leth; Østerdal, Lars Peter; Yu, Yi
In the present paper we describe the structure of the Chinese health care system and sketch its future development. We analyse issues of provider incentives and the actual burden sharing between government, enterprises and people. We further aim to identify a number of current problems and link...
Somasundaram, D. J.; van de Put, W. A.
An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization. PMID:10212521
Somasundaram, D. J.; van de Put, W. A.
An effort is being made in Cambodia to involve grass-roots personnel in the integration of the care of the mentally ill into a broad framework of health services. This undertaking is examined with particular reference to the work of the Transcultural Psychosocial Organization.
Connor, L R
Health care executives across the country, faced with intense competition, are being forced to consider drastic cost cutting measures as a matter of survival. The entire health care industry is under siege from boards of directors, management and others who encourage health care systems to take actions ranging from strategic acquisitions and mergers to simple "downsizing" or "rightsizing," to improve their perceived competitive positions in terms of costs, revenues and market share. In some cases, management is poorly prepared to work within this new competitive paradigm and turns to consultants who promise that following their methodologies can result in competitive advantage. One favored methodology is reengineering. Frequently, cost cutting attention is focused on the materials management budget because it is relatively large and is viewed as being comprised mostly of controllable expenses. Also, materials management is seldom considered a core competency for the health care system and the organization performing these activities does not occupy a strongly defensible position. This paper focuses on the application of a reengineering methodology to healthcare materials management.
to eat together and lying on the same bed with ocular have far reaching implications in terms of cancers patients. management, prognosis and mortality of ocular cancer. Such individuals may not access available. Further analysis indicates that respondents'. 3,9 education, gender and marital status have no health care ...
This paper reports in detail on a project of Integrated Health Care in cardiology at Nuremberg, Germany. Information on the structure of the contract, the participants, the agreed claiming of benefits and provision of services are provided as well as relevant figures and contact data.
Improving skilled attendants at birth: Experience in a primary health care facility in Rivers State, South-South Nigeria. 1. 2. Ordinioha B. , Seiyefa B. 1Community Medicine Department, University of Port Harcourt Teaching Hospital, Port Harcourt. 2Department of Family Medicine, Niger Delta University Teaching Hospital, ...
Artiklen har fokus på undervisning, planlægning, udvikling og evaluering af et internationalt tværfagligt valgfag Intercultural Health Care and Welfare, der udbydes på Det Sundhedsfaglige og Teknologiske Fakultet på Professionshøjskolen Metropol. Ifølge den tysk-amerikanske professor Iris Varner og...
Anaf, Julia; Baum, Fran; Freeman, Toby; Labonte, Ron; Javanparast, Sara; Jolley, Gwyn; Lawless, Angela; Bentley, Michael
To examine case studies of good practice in intersectoral action for health as one part of evaluating comprehensive primary health care in six sites in South Australia and the Northern Territory. Interviews with primary health care workers, collaborating agency staff and service users (Total N=33); augmented by relevant documents from the services and collaborating partners. The value of intersectoral action for health and the importance of partner relationships to primary health care services were both strongly endorsed. Factors facilitating intersectoral action included sufficient human and financial resources, diverse backgrounds and skills and the personal rewards that sustain commitment. Key constraining factors were financial and time limitations, and a political and policy context which has become less supportive of intersectoral action; including changes to primary health care. While intersectoral action is an effective way for primary health care services to address social determinants of health, commitment to social justice and to adopting a social view of health are constrained by a broader health service now largely reinforcing a biomedical model. Effective organisational practices and policies are needed to address social determinants of health in primary health care and to provide a supportive context for workers engaging in intersectoral action. © 2014 Public Health Association of Australia.
U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...
Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. While that perspective has led to incredible advances in medical sc...
Robinson, James C
The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations.
Kern, T; Kohnen, T
Although many health care reforms have been enacted in the last few years in Germany, many of the key points in the current social health care system have been retained from former times. All those introductions for an effective health care system from the last 150 years beginning with mandatory guild membership via Bismarck's social laws to the modern health care systems in Germany with the current problems of financing the heavy burden in the German budget are reported. Data and facts on the current health care system are provided. In the following two articles of this series ambulatory and inpatient treatment in the light of economic aspects of health care are reported.
Health care technology has become an increasingly visible issue in many countries, primarily because of the rising costs of health care. In addition, many questions concerning quality of care are being raised. Health care technology assessment has been seen as an aid in addressing questions
Giraldo Osorio, Alexandra; Vélez Álvarez, Consuelo
A development process, marked by the re-appearance of the primary health care as the core of health systems, has emerged in Latin America. Governments have made a commitment to renew this strategy as the basis of their health systems. However, these health systems are mainly faced with re-introducing equity values, and there are common challenges such as providing the health systems with trained human resources in sufficient numbers, overcoming the fragmentation/segmentation of the systems, ensuring financial sustainability, improving governance, quality of care and information systems, expanding coverage, preparing to face the consequences of an aging population, the changing epidemiological profile, and increase in the response capacity of the public health system. This article is intended to provide a comprehensive view of the progress and challenges of the inclusion of primary care health systems in Latin American countries. Copyright © 2012 Elsevier España, S.L. All rights reserved.
Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in health care practices raise several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in health care practices as replacements of human care. I analyse them as demands for felt care, good care, private care, and real care. I argue that although these objections cannot stand as good reasons for a general and a priori rejection of AI assistive technolog...
Lukas, Carol VanDeusen; Holmes, Sally K; Cohen, Alan B; Restuccia, Joseph; Cramer, Irene E; Shwartz, Michael; Charns, Martin P
The Institute of Medicine's 2001 report Crossing the Quality Chasm argued for fundamental redesign of the U.S. health care system. Six years later, many health care organizations have embraced the report's goals, but few have succeeded in making the substantial transformations needed to achieve those aims. This article offers a model for moving organizations from short-term, isolated performance improvements to sustained, reliable, organization-wide, and evidence-based improvements in patient care. Longitudinal comparative case studies were conducted in 12 health care systems using a mixed-methods evaluation design based on semistructured interviews and document review. Participating health care systems included seven systems funded through the Robert Wood Johnson Foundation's Pursuing Perfection Program and five systems with long-standing commitments to improvement and high-quality care. Five interactive elements appear critical to successful transformation of patient care: (1) Impetus to transform; (2) Leadership commitment to quality; (3) Improvement initiatives that actively engage staff in meaningful problem solving; (4) Alignment to achieve consistency of organization goals with resource allocation and actions at all levels of the organization; and (5) Integration to bridge traditional intra-organizational boundaries among individual components. These elements drive change by affecting the components of the complex health care organization in which they operate: (1) Mission, vision, and strategies that set its direction and priorities; (2) Culture that reflects its informal values and norms; (3) Operational functions and processes that embody the work done in patient care; and (4) Infrastructure such as information technology and human resources that support the delivery of patient care. Transformation occurs over time with iterative changes being sustained and spread across the organization. The conceptual model holds promise for guiding health care
... html To Your Health: NLM update Transcript Four health care challenges : 10/10/2017 To use the sharing ... to follow up on weekly topics. The U.S. health care delivery system needs to address four challenges in ...
Full Text Available The world population reached 7 billion in 2012, which is 6 billion more than in 1800. This remarkable population growth is the result of several factors like advances in the medical, technological and public health systems resulting in the control and treatment of communicable diseases, the control of pandemics, the end of large-scale wars, improvements in living conditions and the revolutions in the field of agriculture. Because of all these factors, there has been a considerable improvement in the life expectancy of human beings. There is also an alarming reduction in fertility rates. The combination of declining fertility rate and augmented life expectancies has led to a change in the demographics of the population with the strata of older individuals growing faster than the younger individuals. The aging of populations is poised to become the next global public health challenge. Advances in medicine and socioeconomic development have substantially reduced mortality and morbidity rates due to infectious conditions and, to some extent, non-communicable diseases. These demographic and epidemiological changes, coupled with rapid urbanization, modernization, globalization, and accompanying changes in risk factors and lifestyles, have increased the prominence of chronic non-infective conditions. Health systems need to find effective strategies to extend health care and to respond to the needs of older adults. This review highlights the pathophysiology of aging, biological and physiological changes, impact of aging on health, epidemiological transitions, multi-morbidity in elderly and challenges for health care system.
Keijser, Wouter Alexander; Smits, Jacco Gerardus Wilhelmus Leonardus; Penterman, Lisanne; Wilderom, Celeste P.M.
Introduction: Integrated care can prosper from e-health solutions that hold a vast potential for increasing effective information sharing and communication: collaboration. This is in particular the case in the care for elder persons: a growing population often in need of a variety of care, health
Crall, James J
National and state-level evidence has documented ongoing disparities in children's health and utilization of oral health care services, prompting a re-examination of factors associated with poor oral health and low use of oral health services. These efforts have yielded a wide array of proposals for improving children's oral health and oral health care delivery. This paper offers a perspective on the current context of efforts to improve children's oral health and oral health care delivery.
Gruen, Russell L; Elliott, Julian H; Nolan, Monica L; Lawton, Paul D; Parkhill, Anne; McLaren, Cameron J; Lavis, John N
Planning for programme sustainability is a key contributor to health and development, especially in low-income and middle-income countries. A consensus evidence-based operational framework would facilitate policy and research advances in understanding, measuring, and improving programme sustainability. We did a systematic review of both conceptual frameworks and empirical studies about health-programme sustainability. On the basis of the review, we propose that sustainable health programmes are regarded as complex systems that encompass programmes, health problems targeted by programmes, and programmes' drivers or key stakeholders, all of which interact dynamically within any given context. We show the usefulness of this approach with case studies drawn from the authors' experience.
Ploeg, Jenny; Markle-Reid, Maureen; Davies, Barbara; Higuchi, Kathryn; Gifford, Wendy; Bajnok, Irmajean; McConnell, Heather; Plenderleith, Jennifer; Foster, Sandra; Bookey-Bassett, Sue
Improving health care quality requires effective and timely spread of innovations that support evidence-based practices. However, there is limited rigorous research on the process of spread, factors influencing spread, and models of spread. It is particularly important to study spread within the home care sector given the aging of the population, expansion of home care services internationally, the high proportion of older adult users of home care services, and the vulnerability of this group who are frail and live with multiple chronic conditions. The purpose of this study was to understand how best practices related to older adults are spread within home care organizations. Four home care organizations in Ontario, Canada that had implemented best practices related to older adults (falls prevention, pain management, management of venous leg ulcers) participated. Using a qualitative grounded theory design, interviews were conducted with frontline providers, managers, and directors at baseline (n = 44) and 1 year later (n = 40). Open, axial, and selective coding and constant comparison analysis were used. A model of the process of spread of best practices within home care organizations was developed. The phases of spread included (1) committing to change, (2) implementing on a small scale, (3) adapting locally, (4) spreading internally to multiple users and sites, and (5) disseminating externally. Factors that facilitated progression through these phases were (1) leading with passion and commitment, (2) sustaining strategies, and (3) seeing the benefits. Project leads, champions, managers, and steering committees played vital roles in leading the spread process. Strategies such as educating/coaching and evaluating and feedback were key to sustaining the change. Spread occurred within the home care context of high staff and manager turnover and time and resource constraints. Spread of best practices is optimized through the application of the phases of spread
care reform legislation—the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA...Estimated Costs for Compliance Patient Protection and Affordable Care Act (PPACA) and Health Care and Education Reconciliation Act of 2010 (HCERA...including inpatient hospitals, home health agencies, nursing homes, hospice providers, psychiatric hospitals, long-term care hospitals, inpatient
Aug 19, 2016 ... Conclusion: Although Bayelsa is a developing state, a sustainable health financing scheme will depend on a health system that ... tourism. To make the point clear, medical tourism is not mainly about travelling to see foreign doctors but essentially about the export of a state's health finances or finances that ...
Strasser, Roger; Kam, Sophia M; Regalado, Sophie M
Compared to their urban counterparts, rural and remote inhabitants experience lower life expectancy and poorer health status. Nowhere is the worldwide shortage of health professionals more pronounced than in rural areas of developing countries. Sub-Saharan Africa (SSA) includes a disproportionately large number of developing countries; therefore, this article explores SSA in depth as an example. Using the conceptual framework of access to primary health care, sustainable rural health service models, rural health workforce supply, and policy implications, this article presents a review of the academic and gray literature as the basis for recommendations designed to achieve greater health equity. An alternative international standard for health professional education is recommended. Decision makers should draw upon the expertise of communities to identify community-specific health priorities and should build capacity to enable the recruitment and training of local students from underserviced areas to deliver quality health care in rural community settings.
which is regarded as the era of Total Quality Management, Quality of care in primary health care centres leaves much to be desired. This therefore calls for an urgent, deliberate, sustained and purposeful effort to institutionalize Quality Assurance mechanism as an integral part of our health system. Keywords: Quality, Care ...
According to the Institute of Medicine, health care access is defined as "the degree to which people are able to obtain appropriate care from the health care system in a timely manner." Two key components of health care access are medical insurance and having access to a usual source of health care. Recent national data show that 34% of Latino…
Nonhome-based long-term care sustainable living arrangements for elderly people with Alzheimer's is presented. Characteristics contributing to sustainability are discussed. The ultimate goal in sustainable design for older adult communities is a people-centered model of care in environments that improve their quality of life. Without sustainable…
Bayer, R; Callahan, D; Caplan, A L; Jennings, B
The demands of equity and efficiency require a program of universal health insurance in the United States through which all workers will be provided by their employers with health insurance for themselves and their dependents, unemployment will no longer result in the loss of health insurance protection, and federal standards for Medicaid eligibility will be instituted. Issues raised by the assessment of insurance coverage and establishment of uniform standards are discussed within the context of the ethical foundations of medical necessity, schemes for sharing the burden of cost, and the conflict between technological advances and the limitation of resources. Cost containment measures now most prominently on the public agenda represent an unfortunate trend toward exacerbating inequalities by making the patient the main cost container. Moral priority must be given to remedying the patterns of inequality that characterize the American health care system.
Modern affluent societies encounter the challenge of the so-called obesity pandemic in terms of health, and the environmental strain of resource intensive production and consumption in terms of sustainability. Consumer’s role and the consumption side of the supply chain have been identified...... to be crucial in improving healthy choices and achieving sustainability goals, and both issues are increasingly discussed alongside each other. Arguments for why pursuing health and sustainability goals might entail challenges are presented, as well as arguments for why it might allow for synergies...
Kerr, Katelyn; Oram, Joanne; Tinson, Helen; Shum, David
To identify the prevalence of patient aggression against health care workers, the consequences and coping mechanisms. Retrospective cross-sectional design. 50 participants comprised 37 nurses, 1 ward staff, 12 allied health staff employed in two brain injury wards with experience ranging from 3months to 34years. Neurosciences and Brain Injury Rehabilitation wards of a metropolitan tertiary hospital in Brisbane. Researcher designed self-report questionnaire. 98% of respondents had experienced aggression during their health care careers with an average of 143.93 events. Physical injuries had been sustained by 40% of staff, psychological injury by 82%, but only 12% sought treatment. Verbal aggression related to receiving a psychological injury (r=0.305, paggression made it more likely the person would also experience the other types of aggression. Verbal aggression was correlated with physical aggression (r=0.429, pverbal aggression (r=0.286, paggression was correlated with non-verbal aggression (r=0.333, paggression is prevalent and of serious concern for staff working in hospital settings. Copyright © 2017 Elsevier Inc. All rights reserved.
Business school curricula have traditionally emphasized functional skills for people who will work in functional departments and general management skills for people who will organize interdepartmental work. Recently, some business schools have begun to develop programs that teach cross-functional work and team skills to functional specialists. Students educated in such programs will be well prepared to meet the new challenges that health care organizations will face.
Forster Della A
Full Text Available Abstract Objective Research on new models of care in health service provision is complex, as is the introduction and embedding of such models, and positive research findings are only one factor in whether a new model of care will be implemented. In order to understand why this is the case, research design must not only take account of proposed changes in the clinical encounter, but the organisational context that must sustain and normalise any changed practices. We use two case studies where new models of maternity care were implemented and evaluated via randomised controlled trials (RCTs to discuss how (or whether the use of theory might inform implementation and sustainability strategies. The Normalisation Process Model is proposed as a suitable theoretical framework, and a comparison made using the two case studies – one where a theoretical framework was used, the other where it was not. Context and approach In the maternity sector there is considerable debate about which model of care provides the best outcomes for women, while being sustainable in the organisational setting. We explore why a model of maternity care – team midwifery (where women have a small group of midwives providing their care – that was implemented and tested in an RCT was not continued after the RCT’s conclusion, despite showing the same or better outcomes for women in the intervention group compared with women allocated to usual care. We then discuss the conceptualisation and rationale leading to the use of the ‘Normalisation Process Model' as an aid to exploring aspects of implementation of a caseload midwifery model (where women are allocated a primary midwife for their care that has recently been evaluated by RCT. Discussion We demonstrate how the Normalisation Process Model was applied in planning of the evaluation phases of the RCT as a means of exploring the implementation of the caseload model of care. We argue that a theoretical understanding of
The five leading issues identified, in order of importance, were 1. The need for treatment outcome and efficacy data. 2. The need for changes in clinical and academic preparation of entry-level practitioners. 3. The lack of inclusion or use of services for communication and related disorders in public and private health care programs. 4. The need for greater professional autonomy within the health care system. 5. The need to improve services to underserved populations with communication and related disorders. This report was forwarded to key National Office staff and appropriate ASHA boards, councils, and committees for the purposes of determining its feasibility and developing a national plan for action. The feasibility and action plan will detail completed, ongoing and future activities of the Association related to each issue, recommendation, and strategy. Periodic review of the actions taken and progress achieved will be monitored by the Executive Board, other appropriate boards and councils, and designated National Office staff. The plan represents a progressive view of needed change for the professions of speech-language pathology and audiology within the context of the broader health care delivery system.
Romero, Isabel; Carnero, María Carmen
The aim of this research is to design a multi-criteria model for environmental assessment of health care organizations. This is a model which guarantees the objectivity of the results obtained, is easy to apply, and incorporates a series of criteria, and their corresponding descriptors, relevant to the internal environmental auditing processes of the hospital. Furthermore, judgments were given by three experts from the areas of health, the environment, and multi-criteria decision techniques. From the values assigned, geometric means were calculated, giving weightings for the criteria of the model. This innovative model is intended for application within a continuous improvement process. A practical case from a Spanish hospital is included at the end. Information contained in the sustainability report provided the data needed to apply the model. The example contains all the criteria previously defined in the model. The results obtained show that the best-satisfied criteria are those related to energy consumption, generation of hazardous waste, legal matters, environmental sensitivity of staff, patients and others, and the environmental management of suppliers. On the other hand, those areas returning poor results are control of atmospheric emissions, increase in consumption of renewable energies, and the logistics of waste produced. It is recommended that steps be taken to correct these deficiencies, thus leading to an acceptable increase in the sustainability of the hospital.
Willis, Cameron David; Saul, Jessie; Bevan, Helen; Scheirer, Mary Ann; Best, Allan; Greenhalgh, Trisha; Mannion, Russell; Cornelissen, Evelyn; Howland, David; Jenkins, Emily; Bitz, Jennifer
The questions addressed by this review are: first, what are the guiding principles underlying efforts to stimulate sustained cultural change; second, what are the mechanisms by which these principles operate; and, finally, what are the contextual factors that influence the likelihood of these principles being effective? The paper aims to discuss these issues. The authors conducted a literature review informed by rapid realist review methodology that examined how interventions interact with contexts and mechanisms to influence the sustainability of cultural change. Reference and expert panelists assisted in refining the research questions, systematically searching published and grey literature, and helping to identify interactions between interventions, mechanisms and contexts. Six guiding principles were identified: align vision and action; make incremental changes within a comprehensive transformation strategy; foster distributed leadership; promote staff engagement; create collaborative relationships; and continuously assess and learn from change. These principles interact with contextual elements such as local power distributions, pre-existing values and beliefs and readiness to engage. Mechanisms influencing how these principles sustain cultural change include activation of a shared sense of urgency and fostering flexible levels of engagement. The principles identified in this review, along with the contexts and mechanisms that influence their effectiveness, are useful domains for policy and practice leaders to explore when grappling with cultural change. These principles are sufficiently broad to allow local flexibilities in adoption and application. This is the first study to adopt a realist approach for understanding how changes in organizational culture may be sustained. Through doing so, this review highlights the broad principles by which organizational action may be organized within enabling contextual settings.
U.S. Department of Health & Human Services — The Affordable Care Act (Section 1139B) requires the Secretary of HHS to identify and publish a core set of health care quality measures for adult Medicaid...
Piper, Llewellyn E
Passion in today's health care leaders is essential as health care organizations face increasing demands for survival. Leaders in health care have been educated, selected, promoted, and retained based on their analytical and creativity skills. Today's health care leaders must also have emotional intelligence. Emotional intelligence is primal for passion. Emotional intelligence, which leads to passion, is crucial to the survivability of today's health care organizations. In order for health care organizations to go from good to great, the leader must inspire followers through passion. This article encourages health care leaders to gain awareness of emotional intelligence and to use emotional intelligence as part of their leadership to inspire passion. Through passion, leaders and followers become more motivated to accomplish the health care mission of serving others.
... consider, including What your insurance covers Whether a health care provider or service is accredited The location of a service Hours ... ll find information to help you choose a health care provider or service.
This article discusses ways to lesson the restrictions on health development in sub-Saharan Africa caused by limited public health budgets. Health improvements can be funded by the implementation of health insurance, the use of foreign aid, the raising of taxes, the reallocation of public money, and direct contributions by users or households either in the form of charges for services received or prepayments for future services. Community financing, i.e. the direct financing of health care by households in villages or distinct urban communities, is seen as preferable to a national or regional plan. When community financing is chosen, a choice must then be made between direct payment, fee-for-service, and prepayment (insurance) systems. The 3 systems, using the example of an essential drugs program, are described. Theoretically, with direct payment the government receives full cost recovery, and the patients receive the drugs they need, thereby improving their health. Of course the poor may not be able to purchase the drugs, therefore a subsidy system must be worked out at the community level. Fee-for-service means charging for a consultation or course of treatment, including drugs. A sliding scale of fees or discounts for certain types of consultations (e.g. pre-and post natal) can be used. In fee-for-service the risk is shared; because the cost of drugs is financed by the fees, those who receive costly treatments are subsidized by those whose treatments are relatively inexpensive. With prepayment or health insurance the risk of illness is shifted from the patient to the insurance firm or state. 2 issues make insurance plans hard to implement. When patients are covered by insurance, they may demand "too much" medical care (moral hazard) and thus premiums may be too small to cover treatment costs. On the other hand, people in low-risk groups may be unwilling to pay a higher premium, thus leading to adverse selection. Eventually, premiums may rise to the point where
Feagin, Joe; Bennefield, Zinobia
This article draws upon a major social science theoretical approach-systemic racism theory-to assess decades of empirical research on racial dimensions of U.S. health care and public health institutions. From the 1600s, the oppression of Americans of color has been systemic and rationalized using a white racial framing-with its constituent racist stereotypes, ideologies, images, narratives, and emotions. We review historical literature on racially exploitative medical and public health practices that helped generate and sustain this racial framing and related structural discrimination targeting Americans of color. We examine contemporary research on racial differentials in medical practices, white clinicians' racial framing, and views of patients and physicians of color to demonstrate the continuing reality of systemic racism throughout health care and public health institutions. We conclude from research that institutionalized white socioeconomic resources, discrimination, and racialized framing from centuries of slavery, segregation, and contemporary white oppression severely limit and restrict access of many Americans of color to adequate socioeconomic resources-and to adequate health care and health outcomes. Dealing justly with continuing racial "disparities" in health and health care requires a conceptual paradigm that realistically assesses U.S. society's white-racist roots and contemporary racist realities. We conclude briefly with examples of successful public policies that have brought structural changes in racial and class differentials in health care and public health in the U.S. and other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.
Bara, AC; van den Heuvel, WJA; Maarse, JAM; Bara, Ana Claudia; Maarse, Johannes A.M.
Aim. To describe health care reforms and analyze the transition of the health care system in Romania in the 1989-2001 period. Method. We analyzed policy documents, political intentions and objectives of health care reform, described new legislation, and presented changes in financial resources of
Cutler, David M.
Health care is one of the economy's biggest industries, so it is natural that the health care industry should play some role in the teaching of introductory economics. There are many ways that health care can appear in such a context: in the teaching of microeconomics, as a macroeconomic issue, to learn about social welfare, and even to learn how…
Brink-Muinen, A. van den
Differences are investigated between female practice populations of female general practitioners providing women's health care and of women and men general practitioners providing regular health care. Women's health care in the Netherlands is provided in the general practice "Aletta" and is based
Kovacić, L; Sosić, Z
Description and analysis of the present situation of health care system in Croatia, and its characteristics in the transitional process of restructuring. A descriptive method was used. The data from the regular statistical publications were used for the analysis. Croatia is faced with problems similar to those in other countries of the Central and Eastern Europe (CEE), such as control of health expenditure, balancing the development of different segments of health care services, stabilization of effectiveness and quality of care, transition from one-party system to pluralistic democracy, introduction of a free market economy, war devastations, etc. On the other hand, the Croatian experience in the development of a decentralized and integrated primary health care, decentralized health insurance system, education of general/family practitioners, and a tradition in the implementation and development of public health measures, have facilitated and contributed positively to the whole process of transition. In contrast to the economic difficulties, war devastations, and changing the social system, the Croatian health care system proved its stability and sustainability. The highest priority and needs are now related to coping with unhealthy behavior of the population, such as smoking, accidents, physical inactivity, and nutritional problems, which should be solved and controlled by the implementation of preventive programs, organization and management of public health services, and further focusing onto the integrated type of primary health care in the organization of services. Hospital services need more intensive and skilled management, as well as support measures for better quality of work.
El-Shinawi, Mohamed; McCunn, Maureen; Sisley, Amy C; El-Setouhy, Maged; Hirshon, Jon Mark
As one of the leading causes of death and disability in the world, human trauma and injury disproportionately affects individuals in developing countries. To meet the need for improved trauma care in Egypt, the Sequential Trauma Emergency/Education ProgramS (STEPS) course was created through the collaborative effort of U.S. and Egyptian physicians. The objective of course development was to create a high-quality, modular, adaptable, and sustainable trauma care course that could be readily adopted by a lower- or middle-income country. We describe the development, transition, and host nation sustainability of a trauma care training course between a high-income Western nation and a lower-middle-income Middle Eastern/Northern African country, including the number of physicians trained and the challenges to program development and sustainability. STEPS was developed at the University of Maryland, based in part on World Health Organization's Emergency and Trauma Care materials, and introduced to the Egyptian Ministry of Health and Population and Ain Shams University in May 2006. To date, 639 physicians from multiple specialties have taken the 4-day course through the Ministry of Health and Population or public/governmental universities. In 2008, the course transitioned completely to the leadership of Egyptian academic physicians. Multiple Egyptian medical schools and the Egyptian Emergency Medicine Board now require STEPS or its equivalent for physicians in training. Success of this collaborative educational program is demonstrated by the numbers of physicians trained, the adoption of STEPS by the Egyptian Emergency Medicine Board, and program continuance after transitioning to in-country leadership and trainers. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
The Centre for Palliative Care, based at the only medical university [Bangabandhu Sheikh Mujib Medical University (BSMMU)] in Dhaka, Bangladesh, in collaboration with Worldwide Hospice Palliative Care Alliance, piloted a one-year project focussed on improving the quality of life of 100 older people and their families in two slum settings in Dhaka. This project was developed following the identification of significant palliative care needs of older people in the slum settings. In addition, the project was formed in response to the absence of programmes delivering palliative care to the poorest and most marginalised in poor urban settings, in a sustainable manner within the context of the low development of palliative care and the human and financial resource limitations in Bangladesh. The programme was developed using a participatory approach which focussed on engaging members of the community in the delivery of the project through the identification and training of 8 palliative care assistants from the slum setting itself, who delivered basic care supported by health professionals, the development of palliative care activists within the community and the engagement of the slum community leadership. The impact of the project showed improved quality of life for the target population and the potential for further development as a sustainable, community owned model over a further 2 years, which could be translated into other urban settings. This presentation will highlight lessons learned from the development and implementation of the project, and findings from the independent evaluation completed in December 2016, overseen by Glasgow University. The presentation will outline the successes and challenges of developing a participatory, community owned palliative care service within a slum in Dhaka, Bangladesh for older people and their families.
Vanvactor, Jerry D
In contemporary organizations, a wide gamut of options is available for sustaining and supporting health care operations. When disaster strikes, despite having tenable plans for routine replenishment and operations, many organizations find themselves ill-prepared, ill-equipped, and without effective mechanisms in place to sustain operations during the immediate aftermath of a crisis. Health care operations can be abruptly halted due to the non-availability of supply. The purpose of this work is to add to a necessary, growing body of works related specifically to health care logistics preparedness and disaster mitigation. Logistics management is a specialized genre of expertise within the health care industry and is largely contributive to the success or failure of health care organizations. Logistics management requires extensive collaboration among multiple stakeholders-internal and external to an organization. Effective processes and procedures can be largely contributive to the success or failure of organizational operations. This article contributes to the closure of an obvious gap in professional and academic literature related to disaster health care logistics management and provides timely insight into a potential problem for leaders industry-wide. One critical aspect of disaster planning is regard for competent logistics management and the effective provision of necessary items when they are needed most. In many communities, there seems to be little evidence available regarding health care logistics involvement in disaster planning; at times, evidence of planning efforts perceptibly end at intra-organizational doors within facilities. Strategic planners are being continually reminded that health care organizations serve a principal role in emergency preparedness planning and must be prepared to fulfill the associated possibilities without notification. The concern is that not enough attention is being paid to repeated lessons being observed in disasters and
VanVactor, Jerry D.
In contemporary organizations, a wide gamut of options is available for sustaining and supporting health care operations. When disaster strikes, despite having tenable plans for routine replenishment and operations, many organizations find themselves ill-prepared, ill-equipped, and without effective mechanisms in place to sustain operations during the immediate aftermath of a crisis. Health care operations can be abruptly halted due to the non-availability of supply. The purpose of this work is to add to a necessary, growing body of works related specifically to health care logistics preparedness and disaster mitigation. Logistics management is a specialized genre of expertise within the health care industry and is largely contributive to the success or failure of health care organizations. Logistics management requires extensive collaboration among multiple stakeholders—internal and external to an organization. Effective processes and procedures can be largely contributive to the success or failure of organizational operations. This article contributes to the closure of an obvious gap in professional and academic literature related to disaster health care logistics management and provides timely insight into a potential problem for leaders industry-wide. One critical aspect of disaster planning is regard for competent logistics management and the effective provision of necessary items when they are needed most. In many communities, there seems to be little evidence available regarding health care logistics involvement in disaster planning; at times, evidence of planning efforts perceptibly end at intra-organizational doors within facilities. Strategic planners are being continually reminded that health care organizations serve a principal role in emergency preparedness planning and must be prepared to fulfill the associated possibilities without notification. The concern is that not enough attention is being paid to repeated lessons being observed in disasters
Full Text Available Abstract Background New methods for prevention and health promotion and are constantly evolving; however, positive outcomes will only emerge if these methods are fully adopted and sustainable in practice. To date, limited attention has been given to sustainability of health promotion efforts. This study aimed to explore facilitators, barriers, and requirements for sustainability as experienced by professionals two years after finalizing the development and implementation of a multisectoral child health promotion programme in Sweden (the Salut programme. Initiated in 2005, the programme uses a 'Salutogenesis' approach to support health-promoting activities in health care, social services, and schools. Methods All professionals involved in the Salut Programme's pilot areas were interviewed between May and September 2009, approximately two years after the intervention package was established and implemented. Participants (n = 23 were midwives, child health nurses, dental hygienists/dental nurses, and pre-school teachers. Transcribed data underwent qualitative content analysis to illuminate perceived facilitators, barriers, and requirements for programme sustainability. Results The programme was described as sustainable at most sites, except in child health care. The perception of facilitators, barriers, and requirements were largely shared across sectors. Facilitators included being actively involved in intervention development and small-scale testing, personal values corresponding to programme intentions, regular meetings, working close with collaborators, using manuals and a clear programme branding. Existing or potential barriers included insufficient managerial involvement and support and perceived constraints regarding time and resources. In dental health care, barriers also included conflicting incentives for performance. Many facilitators and barriers identified by participants also reflected their perceptions of more general and forthcoming
Kinley, Julie; Stone, Louisa; Butt, Anna; Kenyon, Barbara; Lopes, Nuno Santos
In the UK 15.8% of people aged 85 years and over live in a care home or long-stay hospital setting. With the projection of an ageing population it is realistic to expect that the number of people both living and dying in all care homes will increase. This article describes the implementation of an end-of-life care programme to empower staff to meet their resident's end-of-life care needs. To implement an end-of-life care programme, namely the 'Steps to Success' programme, in residential care homes. Measurable outcomes were collected through audit. Over four years audit of all deceased residents' records in the participating homes was collected. This shows an increase of home deaths in 2011/12 to 2014/15 from 44% (n=8/18) within four residential care homes to 64% (n=74/115) in 23 residential care homes with corresponding increase in advance care plan discussions and completion of 'do not attempt cardiopulmonary resuscitation' forms. Achieving change is any organisation let alone sustaining such change is not easy. Six factors enabled this to occur and these should be considered when implementing other such initiatives in residential care homes.
Kriseman, Jeffrey Michael
This work involved the analysis of a public health system, and the design, development and deployment of enterprise informatics architecture, and sustainable community methods to address problems with the current public health system. Specifically, assessment of the Nationally Notifiable Disease Surveillance System (NNDSS) was instrumental in…
Background: Despite the long existence of community health insurance schemes (CHI) in Uganda, their numbers and coverage levels have remained small with limited accessibility by the poor. Objectives: To examine issues of equity and sustainability in CHI schemes, which are prerequisites to health sector financing.
Create structures to increase user safety as well as attracting investment and making money the prevalence in different parts of the country can benefit. For people to have this design can be found in different locations accomplished and the success and benefits enjoyed it. Keywords: Health; city health; smart; sustainability ...
This study examines how Health Management Information Systems (HMIS) can be sustained in the Tanzanian context based on the experiences of Muheza and Kinondoni districts. Data for the study was collected using interviews, questionnares and document reviews. The findings show that the capability of a health facility ...
Wees, P.J. van der; Zaslavsky, A.M.; Ayanian, J.Z.
CONTEXT: Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts
Kimmey, James R.
A discussion of the implications of health care reform for academic health centers (a complex of institutions which educate health professionals) looks at problems in the current system, the role of academic health centers in the current system, financial pressures, revenue sources other than patient care, impact on health research, and human…
The main objective was to estimate sector wide disease speciﬁc cost of health care intervention at health ... [Afr J. Health Sci. 2002; 9: 69-79]. Introduction interest in the costs of health care interventions derives from the desire to undertake economic evaluation that are input in health .... accounting procedure. It is based on ...
There are many challenges facing the health system in the 21st century - the majority of which are related to managing demand for health services. To meet these challenges emerging GP commissioning consortia will need to take a new approach to commissioning health services - an approach that moves beyond the current acute-centred curative paradigm of care to a new sustainable paradigm of care that focuses on primary care, integrated services and upstream prevention to manage demand. A key part of this shift is the recognition that the health system does not operate in a vacuum and that strategic commissioning decisions must take account of wider determinants of health and well-being, and operate within the finite limits of the planet's natural resources. The sustainable development principle of balancing financial, social and environmental considerations is crucial in managing demand for health services and ensuring that the health system is resilient to risks of resource uncertainty and a changing climate. Building sustainability into the governance and contracting processes of GP commissioning consortia will help deliver efficiency savings, impact on system productivity, manage system risk and help manage demand through the health co-benefits of taking a whole systems approach to commissioning decisions. Commissioning services from providers committed to corporate social responsibility and sustainable business practices allows us to move beyond a health system that cures people reactively to one in which the health of individuals and populations is managed proactively through prevention and education. The opportunity to build sustainability principles into the culture of GP commissioning consortia upfront should be seized now to ensure the new model of commissioning endures and is fit for the future.
Morgan, Rosemary; Tetui, Moses; Muhumuza Kananura, Rornald; Ekirapa-Kiracho, Elizabeth; George, A S
Despite its reduction over the last decade, the maternal mortality rate in Uganda remains high, due to in part a lack of access to maternal health care. In an effort to increase access to care, a quasi-experimental trial using vouchers was implemented in Eastern Uganda between 2009 and 2011. Findings from the trial reported a dramatic increase in pregnant women's access to institutional delivery. Sustainability of such interventions, however, is an important challenge. While such interventions are able to successfully address immediate access barriers, such as lack of financial resources and transportation, they are reliant on external resources to sustain them and are not designed to address the underlying causes contributing to women's lack of access, including those related to gender. In an effort to examine ways to sustain the intervention beyond external financial resources, project implementers conducted a follow-up qualitative study to explore the root causes of women's lack of maternal health care access and utilization. Based on emergent findings, a gender analysis of the data was conducted to identify key gender dynamics affecting maternal health and maternal health care. This paper reports the key gender dynamics identified during the analysis, by detailing how gender power relations affect maternal health care access and utilization in relation to: access to resources; division of labour, including women's workload during and after pregnancy and lack of male involvement at health facilities; social norms, including perceptions of women's attitudes and behaviour during pregnancy, men's attitudes towards fatherhood, attitudes towards domestic violence, and health worker attitudes and behaviour; and decision-making. It concludes by discussing the need for integrating gender into maternal health care interventions if they are to address the root causes of barriers to maternal health access and utilization and improve access to and use of maternal health
Moyano-Santiago, Miguel A; Rivera-Lirio, Juana M
To determine the degree to which the health plans of the autonomous communities focus on the usual three dimensions of sustainability: economic, social and environmental, both in the general level of discourse and in the different areas of intervention. A qualitative study was conducted through content analysis of a large sample of documents. The specific methodology was analysis of symbolic and operational sensitivity in a sample of eleven health plans of the Spanish state. Social aspects, such as social determinants or vulnerable groups, are receiving increasing attention from the health planner, although there is room to strengthen attention to environmental issues and to provide specific interventions in economic terms. The analysis demonstrates the incipient state of health plans as strategic planning documents that integrate economic, social and environmental aspects and contribute to the sustainability of the different health systems of the country. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.
Deutsch, Stephanie Anne; Fortin, Kristine
Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed. Copyright © 2015 Mosby, Inc. All rights reserved.
Context: Health care at the primary level is accepted as the model for delivering basic health care to low income populations especially in developing countries such as Nigeria. Despite all the efforts and strategiesadapted in Nigeria, there is still high level of morbidity and mortality from the diseases primary health care ...
Irwin, Charles E., Jr., Ed.; And Others
Health care reform represents a major step toward achieving the goal of improved preventive and primary care services for all Americans, including children and adolescents. Adolescence is a unique developmental age district from both childhood and adulthood with special vulnerabilities, health concerns, and barriers to accessing health care. It is…
Background: data from different studies showed health care behaviour and estimated per capita health care expenditure for the general population, but the specific data for infants at different levels of care are lacking. The objectives of this study were to describe mothers' health service utilization during pregnancy and ...
Maria Cristina Barbaro
Full Text Available OBJECTIVE: evaluate prenatal care for adolescents in health units, in accordance with the attributes of Primary Health Care (PHC guidelines. METHOD: quantitative study conducted with health professionals, using the Primary Care Assessment Tool-Brazil to assess the presence and extent of PHC attributes. RESULTS: for all the participating units, the attribute Access scored =6.6; the attributes Longitudinality, Coordination (integration of care, Coordination (information systems and Integrality scored =6.6, and the Essential Score =6.6. Comparing basic units with family health units, the attribute scores were equally distributed; Accessibility scored =6.6, the others attributes scored =6.6; however, in the basic units, the Essential Score was =6.6 and, in the family health units, =6.6. CONCLUSION: expanding the coverage of family health units and the training of professionals can be considered strategies to qualify health care.
Ostojić, Rajko; Bilas, Vlatka; Franc, Sanja
The main aim of the research done in this paper was to establish key challenges and perspectives for health care development in the Republic of Croatia in the next two decades. Empirical research was conducted in the form of semi-structured interviews involving 49 subjects, representatives of health care professionals from both, public and private sectors, health insurance companies, pharmaceutical companies, drug wholesalers, and non-governmental organisations (patient associations). The results have shown that key challenges and problems of Croatian health care can be divided into three groups: functioning of health care systems, health care personnel, and external factors. Research has shown that key challenges related to the functioning of health care are inefficiency, financial unviability, inadequate infrastructure, and the lack of system transparency. Poor governance is another limiting factor. With regard to health care personnel, they face the problems of low salaries, which then lead to migration challenges and a potential shortage of health care personnel. The following external factors are deemed to be among the most significant challenges: ageing population, bad living habits, and an increase in the number of chronic diseases. However, problems caused by the global financial crisis and consequential macroeconomic situation must not be neglected. Guidelines for responding to challenges identified in this research are the backbone for developing a strategy for health care development in the Republic of Croatia. Long-term vision, strategy, policies, and a regulatory framework are all necessary preconditions for an efficient health care system and more quality health services.
Tomkins, Andrew; Duff, Jean; Fitzgibbon, Atallah; Karam, Azza; Mills, Edward J; Munnings, Keith; Smith, Sally; Seshadri, Shreelata Rao; Steinberg, Avraham; Vitillo, Robert; Yugi, Philemon
Differences in religious faith-based viewpoints (controversies) on the sanctity of human life, acceptable behaviour, health-care technologies and health-care services contribute to the widespread variations in health care worldwide. Faith-linked controversies include family planning, child protection (especially child marriage, female genital mutilation, and immunisation), stigma and harm reduction, violence against women, sexual and reproductive health and HIV, gender, end-of-life issues, and faith activities including prayer. Buddhism, Christianity, Hinduism, Islam, Judaism, and traditional beliefs have similarities and differences in their viewpoints. Improved understanding by health-care providers of the heterogeneity of viewpoints, both within and between faiths, and their effect on health care is important for clinical medicine, public-health programmes, and health-care policy. Increased appreciation in faith leaders of the effect of their teachings on health care is also crucial. This Series paper outlines some faith-related controversies, describes how they influence health-care provision and uptake, and identifies opportunities for research and increased interaction between faith leaders and health-care providers to improve health care. Copyright © 2015 Elsevier Ltd. All rights reserved.
M.Cur. (Nursing Administration) With the Declaration of Alma Ata in September, 1978, a new era in health care delivery, the primary health care era with its slogan of "health for all by the year 2000' dawned. Much thought had to be put into new legislation and reorganizing of health services in South Africa. Soweto, devastated by riots in 1976, suffered badly when all health care services collapsed. Out of this crisis was born a primary health care service that provides Soweto with prevent...
Sorrell, Jeanne M
Health care was an important issue for both the Obama and McCain election campaigns. Now that Barack Obama is poised to serve as the 44th President of the United States, many health care providers are focused on what Obama's administration will mean for new health care initiatives. This article focuses specifically on aspects of the Obama and Biden health care plan that affects mental health care for older adults.
Udvarhelyi, I S; Relman, A S; Binder, G M; Spence, R K; Kennedy, E M; Grossman, J H; Termeer, H A; Raines, L J; Marincola, E; Pyle, T O
In "Making Competition in Health Care Work" (July-August 1994), Elizabeth Olmsted Teisberg, Michael E. Porter, and Gregory B. Brown ask a question that has been absent from the national debate on health care reform: How can the United States achieve sustained cost reductions while at the same time maintaining quality of care? The authors argue that innovation driven by rigorous competition is the key to successful reform. A lasting cure for health care in the United States should include four basic elements: corrected incentives to spur productive competition, universal insurance to secure economic efficiency, relevant information to ensure meaningful choice, and innovation to guarantee dynamic improvement. In this issue's Perspectives section, eleven experts examine the current state of the health care system and offer their views on the shape that reform should take. Some excerpts: "On the road to innovation, let us not forget to develop the tools that allow physicians, payers, and patients to make better decisions." I. Steven Udvarhelyi; "Health care is not a product or service that can be standardized, packaged, marketed, or adequately judged by consumers according to quality and price." Arnold S. Relman; "Just as antitrust laws are the wise restraints that make competition free in other sectors of the economy, so the right kind of managed competition can work well in health care." Edward M. Kennedy "Biomedical research should be considered primarily an investment in the national economic well-being with additional humanitarian benefits." Elizabeth Marincola.
... available at a drop-in clinic. Some large companies provide access to virtual doctors' offices as a ... https://www.niddk.nih.gov/health-information/health-communication-programs/ndep/health-care-professionals/practice-transformation/information- ...
J.J.M. Barendregt (Jan); L.G.A. Bonneux (Luc); P.J. van der Maas (Paul)
textabstractBACKGROUND: Although smoking cessation is desirable from a public health perspective, its consequences with respect to health care costs are still debated. Smokers have more disease than nonsmokers, but nonsmokers live longer and can incur more health costs
U.S. Department of Health & Human Services — The data was derived from the Health Care Information System (HCIS), which contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency (Part A...
... Groups Health and Wellness Outreach Materials Posters Safety Gun Safety Medication Safety Reproductive Health Healthy Pregnancy Preconception ... where specific authority is given to VA by law. Contact your nearest VA health care facility (found ...
Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes
.... The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in global health...
Fernández i Alegre, Roser; Argenter i Giralt, Miquel; Rodríguez i Guasch, Xavier
The aim of a health system and the priority of any government is to anticipate problems before they appear, provide an innovative response to these new needs and healthcare models, improve access of the general public and patients to health care, especially care for the most vulnerable groups, improve healthcare results and implement the structural reforms necessary to maintain a viable and sustainable quality public healthcare system for everyone. In the current environment, health systems are facing new economic, demographic, care, social, technological and political paradigms to which health policy must respond. Faced with these challenges, health systems, especially in the case of Catalonia, are challenged to take decisions on how best to approach the implementation of structural reform designed to facilitate the necessary economic and fiscal sustainability in the service of fresh and innovative health policies and patient-centred care within a system marked by excellence and equity. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. While that perspective has led to incredible advances in medical science, it now may be adversely affecting value. Problem-oriented care is clearly one of the drivers of rising costs and it could be adversely affecting the quality of care, depending upon how quality is defined. If we redefined health in terms of patient-centered goals, health care could be focused more directly on meaningful outcomes, reducing the number of irrelevant tests and treatments. Greater emphasis would be placed on prevention, meaningful activities, advance directives and personal growth and development. The role of patients within clinician-patient relationships would be elevated, strengthening therapeutic relationships. Reframing health in terms of health-related goals and directing the health care system to help people achieve them, could both improve quality and reduce costs. In the process, it could also make health care less mechanical and more humane.
Bystedt, Maria; Eriksson, Maria; Wilde-Larsson, Bodil
To describe how registered nurses (RNs) perceive delegation to unlicensed personnel (UP) in a municipal healthcare context in Sweden. Within municipal health care RNs often delegate tasks to UP. The latter have practical training, but lack formal competence. Twelve RNs were interviewed and the material was analysed using a phenomenographic approach. Owing to a shortage of RNs, delegation is seen as a prerequisite for a functioning organization. This necessity also involves a number of perceived contradictions in three areas: (1) the work situation of RNs - facilitation and relief vs. lack of control, powerlessness, vagueness regarding responsibility, and resignation; (2) the relationship with unlicensed personnel - stimulation, possibility for mentoring, use of UP competence and the creation of fairness vs. questioning UP competence; and (3) The patients - increase in continuity, quicker treatment, and increased security vs. insecurity (with respect to, for example, the handling of medicine). Registered nurses perceptions of delegation within municipal healthcare involve their own work situation, the UP and the patients. Registered nurses who delegate to UP must be given time for mentoring such that the nursing care is safe care of high quality. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.
Oster, J; Melches, J
The members of the Bundesarbeitsgemeinschaft Künstlerische Therapien (BAG KT - "Working Committee of Art Therapies of the Federal Republic of Germany") decided to carry out an analysis of the occupational group of art therapists, in the form of an online inquiry. For this purpose, a questionnaire covering all fields of art therapies was developed, recording socio-demographic and qualification data, data of different fields of activity, patient characteristics, institutional conditions and setting as well as data on reimbursement. 2303 evaluable data sets are available. Here, the main focus is on art therapists in the health care sector according to SGB (N=2134). 83% of them are female, 56% work in the field of emergency medicine and curative treatment, followed by rehabilitation and youth welfare. In all sectors, specialization in music and art therapy predominates. 57% of the therapists have a special graduate degree in art therapy methods, 83% have a graduate degree. 42% have a license to work as an alternative non-medical practitioner. Nearly all of them use methods of quality management. The results highlight the implementation of art therapies in health care. © Georg Thieme Verlag KG Stuttgart · New York.
Full Text Available The increasing use of natural rubber latex medical gloves in the last three decades has caused an increase in latex allergy. The majority of risk groups for allergy development include health care workers, workers in the rubber industry, atopic individuals and children with congenital malformations. Three types of pathological reactions can occur in people using latex medical gloves: irritant contact dermatitis, allergic contact dermatitis and immediate hypersensitivity. The latex allergy is caused by constituent components of latex gloves and added powders; there are also numerous latex allergens involved in cross-reactivity between latex and fruits and vegetables, the so-called latex-fruit syndrome. The diagnosis is based on an accurate history of exposure, clinical presentation and confirmatory in vivo and in vitro tests. Prevention is the easiest, most effective and least expensive way to avoid latex allergy. Powder-free latex gloves with reduced levels of proteins and chemicals, and synthetic gloves for allergic workers must be provided in the work environment. There are already many health care institutions around the world where all latex products have been replaced by synthetic material products.
We in health care are living and working in a world that, for all its technical changes, differs little in its basic assumptions, structures, payment systems, beliefs, expectations, and job titles from the world of health care a generation back. How much change can we expect over the coming years? A lot more than we are prepared for. Look at the array of new technologies headed our way, from genomic sciences to customized vaccinations. Many of the breakthroughs promise incredible abilities to prevent disease, to profile our proclivities, and to manage our genetic predispositions over long periods of time, rather than merely wait until the disease manifests in an acute phase, then treat the symptoms. Digital technologies bring physicians executives enormous opportunities for new ways of gathering, storing, and mining information, for new types of communication between medical professionals, for new communications with customers, and new ways of steering large, complex enterprises. Unprecedented opportunities for change keep piling in through the door. Vast pressures for change keep building from every side. And the rewards for anyone who can lead the change keep compounding.
Globalization of health care, flat medicine, cross-boarder health care, medical tourism, are all terms describing some, but not all, aspects of a growing trend: patients seeking health care provision abroad, and health care providers travelling abroad for temporary or permanent health care delivery services. This trend is a complex, bilateral and multifaceted phenomenon, which in our opinion, cannot be sustained in a single, comprehensive description. Individual hospitals have the unique opportunity to develop a model for appropriate action. The specific model created by the university hospital UZ Brussel is presented here.
Finucane, Anne M; Stevenson, Barbara; Moyes, Rhona; Oxenham, David; Murray, Scott A
Internationally, policy calls for care homes to provide reliably good end-of-life care. We undertook a 20-month project to sustain palliative care improvements achieved by a previous intervention. To sustain a high standard of palliative care in seven UK nursing care homes using a lower level of support than employed during the original project and to evaluate the effectiveness of this intervention. Two palliative care nurse specialists each spent one day per week providing support and training to seven care homes in Scotland, United Kingdom; after death audit data were collected each month and analysed. During the sustainability project, 132 residents died. In comparison with the initial intervention, there were increases in (a) the proportion of deceased residents with an anticipatory care plan in place (b) the proportion of those with Do Not Attempt Cardiopulmonary Resuscitation documentation in place and (c) the proportion of those who were on the Liverpool Care Pathway when they died. Furthermore, there was a reduction in inappropriate hospital deaths of frail and elderly residents with dementia. However, overall hospital deaths increased. A lower level of nursing support managed to sustain and build on the initial outcomes. However, despite increased adoption of key end-of-life care tools, hospital deaths were higher during the sustainability project. While good support from palliative care nurse specialists and GPs can help ensure that key processes remain in place, stable management and key champions are vital to ensure that a palliative care approach becomes embedded within the culture of the care home.
Weiss, Marjorie D
Strategically leveraging health and safety initiatives with sustainability and stewardship helps organizations improve profitability and positively impact team member and customer attachment to the organization. Collective efficacy enhances the triple bottom line: healthy people, healthy planet, and healthy profits. The HS(3)™ Best Practice Exchanges group demonstrated that collective efficacy can leverage the social cohesion, communication channels, and activities within workplaces to promote a healthy, sustainable work culture. This in turn (1) protects the health and safety of workers, (2) preserves the natural environment, and (3) increases attachment to the organization. Community-based participatory research using the Attach21 survey assessed the progress of these companies in their efforts to integrate health, safety, sustainability, and stewardship. Monthly Best Practice Exchanges promoted collective efficacy by providing support, encouragement, and motivation to share and adopt new ideas. Copyright 2013, SLACK Incorporated.
Garcia, Victor H; Meek, Kevin L; Wilson, Kimburli A
The changing framework of today's health care system requires leaders to be increasingly innovative in how they approach their daily functions and responsibilities. Sustaining and advancing a level of innovation that already exists can be challenging for health care administrators with the demands of time and resource limitations. Using collaboration to bring new-age teaching and disciplines to front-line leadership, one hospital was able to reinvigorate a culture of innovation through multiple levels and disciplines of the organization. The Innovation Certification Course provided nursing leaders and other managers' an evidence-drive approach, new principles and useful strategies of innovative leadership and graduate program education.
Bridges, Jackie; May, Carl; Fuller, Alison; Griffiths, Peter; Wigley, Wendy; Gould, Lisa; Barker, Hannah; Libberton, Paula
Despite concerns about the degree of compassion in contemporary healthcare, there is a dearth of evidence for health service managers about how to promote compassionate healthcare. This paper reports on the implementation of the Creating Learning Environments for Compassionate Care (CLECC) intervention by four hospital ward nursing teams. CLECC is a workplace educational intervention focused on developing sustainable leadership and work-team practices designed to support team relational capacity and compassionate care delivery. To identify and explain the extent to which CLECC was implemented into existing work practices by nursing staff, and to inform conclusions about how such interventions can be optimised to support compassionate care in acute settings. Process evaluation guided by normalisation process theory. Data gathered included staff interviews (n=47), observations (n=7 over 26 hours) and ward manager questionnaires on staffing (n=4). Frontline staff were keen to participate in CLECC, were able to implement many of the planned activities and valued the benefits to their well-being and to patient care. Nonetheless, factors outside of the direct influence of the ward teams mediated the impact and sustainability of the intervention. These factors included an organisational culture focused on tasks and targets that constrained opportunities for staff mutual support and learning. Relational work in caregiving organisations depends on individual caregiver agency and on whether or not this work is adequately supported by resources, norms and relationships located in the wider system. High cognitive participation in compassionate nursing care interventions such as CLECC by senior nurse managers is likely to result in improved impact and sustainability. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Budde, Kristin S; Friedman, Dovid; Alli, Kemi; Randell, Joan; Kang, Barbara; Feuerstein, Seth D
This column describes a unique model for integrating behavioral health services into two New Jersey federally qualified health centers (FQHCs). The pilot project, funded by a private foundation grant, offers a lens for exploring the distinct challenges and opportunities faced by FQHCs serving diverse populations. The behavioral health services provided through this project were comprehensive, including behavioral health care, chronic disease management, and computerized cognitive-behavioral therapy. Although many changes to health center structure and staffing were required, building on existing infrastructure allowed substantial progress toward implementation of an integrated (and eventually self-sustaining) care system in one year. The challenges facing FQHCs wishing to integrate behavioral health services into their routine operation will vary; this project can provide a blueprint by which comprehensive behavioral health care can be integrated into existing medical clinic services.
Mertens, Elly; Van't Veer, Pieter; Hiddink, Gerrit J; Steijns, Jan Mjm; Kuijsten, Anneleen
Shifting towards a more sustainable food consumption pattern is an important strategy to mitigate climate change. In the past decade, various studies have optimised environmentally sustainable diets using different methodological approaches. The aim of the present review was to categorise and summarise the different approaches to operationalise the health aspects of environmentally sustainable diets. Conventional keyword and reference searches were conducted in PubMed, Scopus, Web of Knowledge and CAB Abstracts. Inclusion criteria were: (i) English-language publication; (ii) published between 2005 and October 2015; (iii) dietary data collected for the diet as a whole at the national, household or individual level; (iv) comparison of the current diet with dietary scenarios; and (v) for results to consider the health aspect in some way. Consumer diets. Adult population. We reviewed forty-nine studies that combined the health and environmental aspects of consumer diets. Hereby, five approaches to operationalise the health aspect of the diet were identified: (i) food item replacements; (ii) dietary guidelines; (iii) dietary quality scores; (iv) diet modelling techniques; and (v) diet-related health impact analysis. Although the sustainability concept is increasingly popular and widely advocated by nutritional and environmental scientists, the journey towards designing sustainable diets for consumers has only just begun. In the context of operationalising the health aspects, diet modelling might be considered the preferred approach since it captures the complexity of the diet as a whole. For the future, we propose SHARP diets: environmentally Sustainable (S), Healthy (H), Affordable (A), Reliable (R) and Preferred from the consumer's perspective (P).
John R. Watt
Full Text Available Taiwan's health services, now among the best in the world, were largely developed after 1947 under conditions of epidemiological and political crisis. Its medical, nursing, and public health leaders knew the importance of focusing on preventive health strategies, and its central government leaders knew how important health care was to the achievement of economic goals. Although there were from time to time setbacks and difficulties, the leadership learned from their mistakes and made effective use of international advice and resources. Taiwan's record makes the case that modernization of health care contributes to economic development and should not be viewed solely as a budgetary cost. Its record provides a mine of information for countries seeking to develop health services compatible with sustained economic and social development.
... U.S. Department of Health and Human Services Indian Health Service The Federal Health Program for American Indians and ... map can be used to find an Indian Health Service, Tribal or Urban Indian Health Program facility. This ...
Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in health care practices raise several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in health care practices as replacements of human care. I analyse them
Background: The National Health Insurance Scheme (NHIS) was formally launched in Nigeria in 2005 as an option to help bridge the evident gaps in health care financing, with the expectation of it leading to significant improvement in the country's dismal health status indices. Primary Health Care (PHC) is the nation's ...
Niiranen, S; Lamminen, H; Mattila, H; Niemi, K; Kalli, S
Personal health care has obtained increasing importance in the field of health care as the populations' age in the industrialised countries and resources available for health care remain limited. Personal health care through digital television is an exiting possibility in the realisation of new types of services answering to this demand for increased personal action and responsibility in health care. The possibilities of digital television in health care are studied in the Health Care Television (HCTV) research project of the Digital Media Institute at Tampere University of Technology. In this paper personal health care services are studied mainly from the perspective of the interactive service infrastructure of digital television. Firstly we present the general infrastructure of digital television and the different interactive service types of digital television. The usage of these service types in personal health care applications is also discussed. Finally, a web-based application based on chronic atrial fibrillation and its test use is presented. The application is used as a research platform for personal health care applications in digital television.
Full Text Available The incentives of health care expenditure (HCE have been a topic of discussion in the USA (Obama reforms and in Europe (adjustment to debt crisis. There are competing views of institutional versus GDP (unit income elasticity and productivity related factors of growth of expenditure. However ageing of populations, technology change and economic incentives related to institutions are also key drivers of growth according to the OECD and EU’s AWG committee. Simulation models have been developed to forecast the growth of social expenditure (including HCEs to 2050. In this article we take a historical perspective to look at the institutional structures and their relationship to HCE growth. When controlling for age structure, price developments, doctor density and in-patient and public shares of expenditures, we find that fee-for-service in primary care, is according to the results, in at least 20 percent more costly than capitation or salary remuneration. Capitation and salary (or wage remuneration are at same cost levels in primary care. However we did not find the cost lowering effect for gatekeeping which could have been expected based on previous literature. Global budgeting 30 (partly DRG based percent less costly in specialized care than other reimbursement schemes like open contracting or volume based reimbursement. However the public integration of purchaser and provider cost seems to result to about 20 higher than public reimbursement or public contracting. Increasing the number of doctors or public financing share results in increased HCEs. Therefore expanding public reimbursement share of health services seems to lead to higher HCE. On the contrary, the in-patient share reduced expenditures. Compared to the previous literature, the finding on institutional dummies is in line with similar modeling papers. However the results for public expansion of services is a contrary one to previous works on the subject. The median lag length of
Full Text Available Although globally there is a change in the trend of epidemiology from infectious diseases to chronic diseases, the prevalence and incidence of infectious diseases as well as MMR (Maternal Mortality Rate and IMR (infant mortality rate in Indonesia is still high. In year 2000, Faculty of Nursing of the Universitas Padjadjaran in collaboration with Hasan Sadikin Hospital built a model of treatment room, which was affiliated with obstetric gynecology room for improving integrated quality of health care services and education. The model built in this room aimed to : 1 Improve the quality of health care service; 2 to develop the student’s experiences with patients; 3 Provide quality nurse education to support students; 4 encourage students to improve the results of clinical prctice. The objective of process evaluation in this study was to give an insight to an appropriate model for maternity nursing service. This results showed on the one hand , there are some records not yet achieved an ideal standard , lack of effectiveness and efficiency of care delivery, namely: 1 the ratio of midwives and patients are not ideal ; 2 No one consultant obstetrician gynecologist and one doctor for every room . As well as challenges to sustainability care that meets the standards of maternity care. Conclusion: this study recommends to take a comprehensive strategic planning for improving nursing and midwifery services that involve all relevant stakeholders in the government, civil society, service delivery, education, and professional organizations.
Stöver, Heino; Wolff, Hans
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Health care professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Health care workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners. PMID:22390510
Pont, Jörg; Stöver, Heino; Wolff, Hans
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue to infringe these principles because of perceived or real dual loyalty to patients and prison authorities. Health care professionals and nonmedical prison staff need greater awareness of and training in medical ethics and prisoner human rights. All parties should accept integration of prison health services with public health services. Health care workers in prison should act exclusively as caregivers, and medical tasks required by the prosecution, court, or security system should be carried out by medical professionals not involved in the care of prisoners.
Christopher G. Hudson
Full Text Available This paper critically reviews the expanding literature on applications of sustainability to healthcare policy and planning. It argues that the concept has been overgeneralized and has become a buzzword masking disparate agendas. It ignores the insights of the newest generation of systems theory on complex systems on the ubiquity of far-from-equilibrium conditions. Yet, a central meaning often ascribed to sustainability is the level continuation of healthcare programs and their institutionalization. Sustainability is only coherent in health care when it is more narrowly delimited to involve public health and treated as only one of several evaluative criteria that informs not only the continuation of programs but more often their expansion or contraction as needs dynamically change.
Hudson, Christopher G.; Vissing, Yvonne M.
This paper critically reviews the expanding literature on applications of sustainability to healthcare policy and planning. It argues that the concept has been overgeneralized and has become a buzzword masking disparate agendas. It ignores the insights of the newest generation of systems theory on complex systems on the ubiquity of far-from-equilibrium conditions. Yet, a central meaning often ascribed to sustainability is the level continuation of healthcare programs and their institutionalization. Sustainability is only coherent in health care when it is more narrowly delimited to involve public health and treated as only one of several evaluative criteria that informs not only the continuation of programs but more often their expansion or contraction as needs dynamically change. PMID:24058914
insurance market, the elderly are at a serious disadvantage in obtaining coverage. Congress established the Medicare program to meet the health care ...not covered by Medicare, 1990a Acupuncture0 Chiropractic services Christian Science practitioners Cosmetic surgery0 Custodial care Dental care0...CRM 95-195 / November 1995 America’s Health: Recent Trends in Health Care Joyce S. McMahon • Michelle A. Dolfini-Reed • John A. Wilson 19960826
Petra Došenovič Bonča
Full Text Available The following paper analyses the possibilities of forming a single European health care market. This aim is achieved by studying the impact of the differing organisational features of individual European health care systems on the efficiency of health care provision, by examining the relationship between the inputs used to produce health care services and the population’s health status in the analysedcountries and by exploring the link between the quantity of health care services and the health status. The authors hypothesise that the efficiency and organisation of health care systems determine the possibilities of forming an efficient single European health care market. The empirical methodology employed in this paper isdata envelopment analysis (DEA. The results show that differences between health care systems and in the ownership types of health care providers are not so large as to prevent the formation of a single European health care market. However, the formation of a single European health care market would reveal the characteristicsof health care systems in such a way that citizens would be in favour of the public sector in health care and the national health service model.
Gawaine Powell Davies
Full Text Available Introduction: To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Description of policy: Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Discussion: Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.
Nielsen, Jennifer L.; Regier, Henry A.; Knudsen, E. Eric
Species of the family of Salmonidae occur naturally in Northern Hemisphere waters that remain clear and cool to cold in summer. For purposes of reproduction, salmonids generally behaviorally respond to the currents of streams and lakes in recently glaciated areas. For feeding and maturation, many larger species migrate into existing systems of large lakes, seas, and oceans. The subfamilies include Salmoninae, Coregoninae, and Thymallinae. In many locales and regions of the hemisphere, numerous species of these subfamilies evolved and self-organized into species flocks or taxocenes of bewildering complexity. For example, any individual species may play different or unique ecological roles in different taxocenes. The northern Pacific and Atlantic Ocean ecosystems, with their seas and tributaries, each contained a metacomplex of such taxocenes that, in their natural state some centuries ago, resembled each other but differed in many ways. Humans have valued all species of this family for subsistence, ceremonial, naturalist, gustatory, angling, and commercial reasons for centuries. Modern progressive humans (MPHs), whose industrial and commercial enterprises have gradually spread over this hemisphere in recent time, now affect aquatic ecosystems at all scales from local to global. These human effects mingle in complex ways that together induce uniquely natural salmonid taxocenes to disintegrate with the loss of species, including those groups least tolerant to human manipulations, but extending more recently to those taxa more adapted to anthropogenic change. As we leave the modern era, dominated by MPHs, will we find ways to live sustainably with salmonid taxocenes that still exhibit self-organizational integrity, or will only individual, isolated populations of salmonid species, derived from those most tolerant of MPHs, survive? To achieve future sustainability of salmonids, we suggest implementation of a search for intuitive knowledge based on faith in the wisdom of
Rodríguez, Tania; Marín, Carlos; Ruiz, Susana; Medina, Jorge; Vázquez, Haddid; Barreda, Maylen; Rojas, Rafael; Latin American Congress on Biomedical Engineering CLAIB
This volume presents the proceedings of the CLAIB 2011, held in the Palacio de las Convenciones in Havana, Cuba, from 16 to 21 May 2011. The confernces of the American Congress of Biomedical Engineering are sponsored by the International Federation for Medical and Biological Engineering (IFMBE), Society for Engineering in Biology and Medicine (EMBS) and the Pan American Health Organization (PAHO), among other organizations and international agencies and bringing together scientists, academics and biomedical engineers in Latin America and other continents in an environment conducive to exchange and professional growth.
Lundqvist, Pontus; Mathson, Anton
Elderly nowadays stay longer in their own home. This raises the standards on home care service to contribute to the maintenance of elderly’s general and oral health. Our objective is therefore to explore attitudes about how home care workers view oral health care and the importance of good oral health for elderly clients. 8 subjects (22 to 61 years of age) were selected for the study working in home care service, which all gave their informed consent. Semi-structured interviews were performed...
3 Austin, V. Medical Data Bases Patient Administration Systems and Biostatistics Activity (PAS&BA) (1986). In Proceedings, 198 AMEDD Forensic ...Health Care Administration, Baylor University, Waco , TX MEMBERSHIP: American Dietetic Association Phi Kappa Phi CERTIFICATION: Registered Dietitian...1986). Proceedings, 1985 AMEDD Forensic Psychology Symrosium, San Antonio, TX: U.S. Army Health Care Studies and Clinical Investigation Activity
Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A
Major health policy creation or changes, including governmental and private policies affecting health care delivery are based on health care reform(s). Health care reform has been a global issue over the years and the United States has seen proposals for multiple reforms over the years. A successful, health care proposal in the United States with involvement of the federal government was the short-lived establishment of the first system of national medical care in the South. In the 20th century, the United States was influenced by progressivism leading to the initiation of efforts to achieve universal coverage, supported by a Republican presidential candidate, Theodore Roosevelt. In 1933, Franklin D. Roosevelt, a Democrat, included a publicly funded health care program while drafting provisions to Social Security legislation, which was eliminated from the final legislation. Subsequently, multiple proposals were introduced, starting in 1949 with President Harry S Truman who proposed universal health care; the proposal by Lyndon B. Johnson with Social Security Act in 1965 which created Medicare and Medicaid; proposals by Ted Kennedy and President Richard Nixon that promoted variations of universal health care. presidential candidate Jimmy Carter also proposed universal health care. This was followed by an effort by President Bill Clinton and headed by first lady Hillary Clinton in 1993, but was not enacted into law. Finally, the election of President Barack Obama and control of both houses of Congress by the Democrats led to the passage of the Affordable Care Act (ACA), often referred to as "ObamaCare" was signed into law in March 2010. Since then, the ACA, or Obamacare, has become a centerpiece of political campaigning. The Republicans now control the presidency and both houses of Congress and are attempting to repeal and replace the ACA. Key words: Health care reform, Affordable Care Act (ACA), Obamacare, Medicare, Medicaid, American Health Care Act.
Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met.
Schaeffer, Leonard D
Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.
In his new book, futurist Russell C. Coile Jr. presents predictions about seven aspects of health care for the next five years. Aided by a panel of health care experts, he analyzes likely developments in health care consumerism, technology, managed care, and other areas that raise a number of issues for health care marketers. Even if only a few of these predictions come true, marketers will be forced to rethink some of their techniques to adapt to this rapidly changing environment.
This article is based on "Salud, ambiente y desarrollo humano sostenible: el caso de México," a document prepared in June 1997 by the Comité Técnico Nacional para el Desarrollo Sostenible. It opens with information regarding the epidemiologic and demographic changes that have taken place in Mexico, such as the decrease in communicable diseases, the rise in noncommunicable diseases, and the less conspicuous increase in lesions resulting from accidents or acts of violence. This is followed by a discussion of priority problems and problems of lesser magnitude in environmental health, specifically those relating to water and air quality, as well as disposal of household and dangerous wastes. Finally, it proposes three areas of intervention in light of the structural problems detected: the absence of an integrated information system covering the area of health, environment, and development; the absence of channels of communication within and between institutions and sectors, and the lack of coordination in planning and implementing programs and actions in this field.
Andersen, Patrea; Horton, Eleanor; Clarke, Karen Ann
Australia faces the challenge of supporting a growing ageing population (AIHW, 2012). Health and safety is paramount in ensuring care is economically sustainable. Nurses involved in healthcare have a responsibility to protect themselves and those being cared for against health and safety risk. Training of the workforce is paramount to reducing the chance of injury (Robson et al. 2012).
Beasley, J.W.; Starfield, B.; Weel, C. van; Rosser, W.W.; Haq, C.L.
A strong primary health care system is essential to provide effective and efficient health care in both resource-rich and resource-poor countries. Although a direct link has not been proven, we can reasonably expect better economic status when the health of the population is improved. Research in
be greater.'4-'6. The broad view. Many factors contribute to one's health: quality and quantity of food, shelter, plumbing, living habits and genetics. What individuals do to themselves and what risks they take determine their relationships with health care professionals and are the foundation of the demand for health care.
Purpose: To evaluate the impact of educational intervention by health care providers on clinical outcomes in type 2 diabetes patients in a Yemeni health facility. Methods: A prospective, one-group and pre- and post-test design to assess the effects of health care providers' education on clinical patient outcomes was ...
Kuenburg, Alexa; Fellinger, Paul; Fellinger, Johannes
Access to health care without barriers is a clearly defined right of people with disabilities as stated by the UN Convention on the Rights of People with Disabilities. The present study reviews literature from 2000 to 2015 on access to health care for deaf people and reveals significant challenges in communication with health providers and gaps in…
Y.G. Pillay; H. Subedar
This paper considers indications and obstacles for the development of primary mental health care practice in both developed and under-developed countries. Both are considered as this represents the South African reality. While a significant body of literature has documented the need for primary mental health care, the obstacles (especially in terms of the commodification of health) to its fruition are seldom addressed.
Alexander K. Lautensach
Full Text Available It seems intuitively clear that not all human endeavours warrant equal concern over the extent of their sustainability. This raises the question about what criteria might best serve for their prioritisation. We refute, on empirical and theoretical grounds, the counterclaim that sustainability should be of no concern regardless of the circumstances. Human security can serve as a source of criteria that are both widely shared and can be assessed in a reasonably objective manner. Using established classifications, we explore how four forms of sustainability (environmental, economic, social, and cultural relate to the four pillars of human security (environmental, economic, sociopolitical, and health-related. Our findings, based on probable correlations, suggest that the criteria of human security allow for a reliable discrimination between relatively trivial incidences of unsustainable behavior and those that warrant widely shared serious concern. They also confirm that certain sources of human insecurity, such as poverty or violent conflict, tend to perpetuate unsustainable behavior, a useful consideration for the design of development initiatives. Considering that human security enjoys wide and increasing political support among the international community, it is to be hoped that by publicizing the close correlation between human security and sustainability greater attention will be paid to the latter and to its careful definition.
Günzel-Jensen, Franziska; Jain, Ajay K.; Kjeldsen, Anne Mette
Management and health care literature is increasingly preoccupied with leadership as a collective social process, and related leadership concepts such as distributed leadership have therefore recently gained momentum. This paper investigates how formal, i.e. transformational, transactional...... and empowering, leadership styles affect employees’ perceived agency in distributed leadership, and whether these associations are mediated by employees’ perceived organizational efficacy. Based on large-scale survey data from a study at one of Scandinavia’s largest public hospitals (N = 1,147), our results show...... that all leadership styles had a significant positive impact on employees’ perceived agency in distributed leadership. Further, organizational efficacy related negatively to employees’ perceived agency in distributed leadership; however a mediatory impact of this on the formal leadership styles...
Casey, Meghan M; Payne, Warren R; Eime, Rochelle M; Brown, Sue J
The involvement of the sport and recreation sector as a setting for health promotion is a new strategy implemented by health policy makers and strategic planners. Strategies to promote and sustain health promotion activities are important considering the risk that programs may cease after initial funding ends. This study explored the factors affecting the sustainability of a sport- and recreation-based health promotion program. A stratified sampling method was used to select four of the nine Regional Sports Assemblies (RSAs) that delivered a state-wide health promotion program funded by the Victorian Health Promotion Foundation in Australia. Data were collected from in-depth interviews with four Executive Officers (EOs) and focus group discussions with their Boards of Management. A sustainability checklist with pre-specified dimensions (e.g. organisational setting, broader community environment, and program design and implementation) guided data collection and analysis. The results showed that the organisational setting and the broader community environment supported program institutionalisation; whilst the design and implementation of the program worked against institutionalisation. The capacity of the organisations to generate new funds for the program was limited; the relationship between the central funding organisation and the Boards of Management was weak; and the program did not support the retention of staff. The engagement of sport and recreation organisations has potential to facilitate health promotion and public health. To enhance organisational capacity and achieve program sustainability, it is important that organisational processes, structures, and resources that support long-term health promotion practice are effectively and efficiently planned and managed.
García, E I; Mira Solves, J J; Guilabert Mora, M
Identifying a minimum set of efficiency indicators calculated from current information sources. Interventions adopted from the analysis of these indicators could contribute to health services sustainability. We applied the discussion group technique. A total of 23 quality coordinators from around the country and the representatives of the regional quality societies in SECA (Spanish Society for Quality in Healthcare) participated. Ten efficiency indicators useful for integrated management areas were identified and accepted, 5 in the area of primary care and 5 for hospital management. The efficiency indicators agreed upon could contribute to the sustainability of the health system without this affecting the quality of care. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.
Greiner, Mary V; Beal, Sarah J
In 2012, the Comprehensive Health Evaluations for Cincinnati's Kids (CHECK) Center was launched at Cincinnati Children's Hospital Medical Center to provide health care for over 1,000 children placed into foster care each year in the Cincinnati community. This consultation model clinical program was developed because children in foster care have been difficult to manage in the traditional health care setting due to unmet health needs, missing medical records, cumbersome state mandates, and transient and impoverished social settings. This case study describes the history and creation of the CHECK Center, demonstrating the development of a successful foster care health delivery system that is inclusive of all community partners, tailored for the needs and resources of the community, and able to adapt and respond to new information and changing systems.
Foyer, Christine H; Lam, Hon-Ming; Nguyen, Henry T; Siddique, Kadambot H M; Varshney, Rajeev K; Colmer, Timothy D; Cowling, Wallace; Bramley, Helen; Mori, Trevor A; Hodgson, Jonathan M; Cooper, James W; Miller, Anthony J; Kunert, Karl; Vorster, Juan; Cullis, Christopher; Ozga, Jocelyn A; Wahlqvist, Mark L; Liang, Yan; Shou, Huixia; Shi, Kai; Yu, Jingquan; Fodor, Nandor; Kaiser, Brent N; Wong, Fuk-Ling; Valliyodan, Babu; Considine, Michael J
The United Nations declared 2016 as the International Year of Pulses (grain legumes) under the banner 'nutritious seeds for a sustainable future'. A second green revolution is required to ensure food and nutritional security in the face of global climate change. Grain legumes provide an unparalleled solution to this problem because of their inherent capacity for symbiotic atmospheric nitrogen fixation, which provides economically sustainable advantages for farming. In addition, a legume-rich diet has health benefits for humans and livestock alike. However, grain legumes form only a minor part of most current human diets, and legume crops are greatly under-used. Food security and soil fertility could be significantly improved by greater grain legume usage and increased improvement of a range of grain legumes. The current lack of coordinated focus on grain legumes has compromised human health, nutritional security and sustainable food production.
We show that when health care providers have market power and engage in Cournot competition, a competitive upstream health insurance market results in over-insurance and over-priced health care. Even though consumers and firms anticipate the price interactions between these two markets - the price set in one market affects the demand expressed in the other - Pareto improvements are possible. The results suggest a beneficial role for Government intervention, either in the insurance or the health care market.
Ashutosh Kumar Verma
Full Text Available Malaysia has a two-tier health care system consisting of the public and private sectors. The Ministry of Health is the main provider of health care services in the country. The private health care sector provides services on a nonsubsidized, fee-for-service basis, and mainly serves for those who can afford to pay. For financing health care two types of health insurances are available currently: Private and employee based (aka SOCSO. SOCSO and Employee Provident Fund provide some coverage to private-sector employees. There are several challenges in pure Bismarckian model (private insurance etc. like smaller portion of total population will be "economically active," international competition to attract firms, and maintain/increase employment will put downward pressure on labor taxes. How to sustain universal coverage in this context? In a population setting where unemployment is high informal sector, payroll taxes will not be a major source of funds. However, it is possible to create a universal health financing system by transforming the role of budget funding from directly subsidizing provision to subsidizing the purchase of services on behalf of the entire population. The integration of services between the public and private sector is very much needed, at a cost the people can afford. At present, there is no national health insurance scheme in place. Although there are many models proposed, the main question that the policymakers need to be aware of is that of the equity of access to holistic health services for all Malaysians.
Kolltveit, Beate-Christin Hope; Gjengedal, Eva; Graue, Marit; Iversen, Marjolein M; Thorne, Sally; Kirkevold, Marit
Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals' experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers. Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-based care, primary care and outpatient hospital clinics were recruited from the intervention arm of an ongoing cluster randomized controlled trial (RCT) (Clinicaltrials.gov: NCT01710774). Most were nurses (n = 29), but the sample also included one nurse assistant, podiatrists (n = 2) and physicians (n = 2). The participants reported experiencing meaningful changes to their practice arising from telemedicine, especially associated with increased wound assessment knowledge and skills and improved documentation quality. They also experienced more streamlined communication between primary health care and specialist health care. Despite obstacles associated with finding the documentation process time consuming, the participants' attitudes to telemedicine were overwhelmingly positive and their general enthusiasm for the innovation was high. Our findings indicate that using a telemedicine intervention enabled the participating health care professionals to approach their patients with diabetic foot ulcer with more knowledge, better wound assessment skills and heightened confidence. Furthermore, it streamlined the communication between health care levels and helped seeing the patients in a more holistic way.
Votruba, Nicole; Thornicroft, Graham
The United Nations' draft Sustainable Development Goals (SDGs) only briefly mention mental health. In the context of a growing burden of disease due to mental disorders and psychosocial disabilities, the inclusion of a clear mental health target and indicators in the SDGs will acknowledge the needs and rights of hundreds of millions of people. It will mobilise international funding and policy development, and support other SDGs; it will also strengthen mental health structures, governance and services in low- and middle-income countries. We argue that for a just, sustainable and inclusive post-2015 development agenda, it is vital that the United Nations includes a clear mental health target and indicators in the SDGs.
Babamoto, Kenneth S.; Sey, Kwa A.; Camilleri, Angela J.; Karlan, Vicki J.; Catalasan, Joana; Morisky, Donald E.
The increasing prevalence of diabetes and obesity, growing health disparities, and shortage of bilingual and culturally trained health care professionals underscore the role of trained community health workers (CHWs) to provide economically sustainable and culturally relevant services. This prospective randomized design evaluated the relative…
This project aims to promote evidence-based policies for improving livestock production, environmental sustainability, and health in the Bolivian Altiplano's rural communities. Traditional farming under threat in Bolivia Raising sheep and llamas is a fundamental economic activity that is threatened by current agricultural ...
The average health care expenditure in infancy was estimated to be 7.92 birr and it increased with increasing level of education and monthly family income. In all treatment ... increase the power of the family to spend some of their earnings for better care. Improving and .... Because of the skewed distribution of health care ...
Newman, Karen; Fisher, Sarah; Mayhew, Susannah; Stephenson, Judith
This article suggests that sexual and reproductive health and rights activists seeking to influence the post-2015 international development paradigm must work with sustainable development advocates concerned with a range of issues, including climate change, environmental issues, and food and water security, and that a way of building bridges with these communities is to demonstrate how sexual and reproductive health and rights are relevant for these issues. An understanding of population dynamics, including urbanization and migration, as well as population growth, can help to clarify these links. This article therefore suggests that whether or not sexual and reproductive health and rights activists can overcome resistance to discussing "population", become more knowledgeable about other sustainable development issues, and work with others in those fields to advance the global sustainable development agenda are crucial questions for the coming months. The article also contends that it is possible to care about population dynamics (including ageing and problems faced by countries with a high proportion of young people) and care about human rights at the same time. It expresses concern that, if sexual and reproductive health and rights advocates do not participate in the population dynamics discourse, the field will be left free for those for whom respecting and protecting rights may be less of a priority. Copyright © 2014 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.
Motwani, J; Sower, V E; Brashier, L W
This article examines the issue of implementing TQM/CQI programs in the health care industry by grouping the prescriptive literature into four research streams. Based on the literature, a strategic programming model for implementing TQM/CQI in the health care industry is suggested. Finally, issues relating to TQM in the health care sector, which need to be addressed within each research stream in the future, are provided.
De Lima, Liliana; Radbruch, Lukas
At the May 2014 meeting of the World Health Assembly, the assembly passed a resolution intended to reduce barriers to palliative care. T4eh resolution calls for integrating palliative care into national health services. It contains recommendation on improved availability and access to such care and calls for it to be included in national health policies and budgets. The full resolution with commentary is presented.
Fisher, Jack E.; Andersen, Zorana J.; Loft, Steffen
The United Nations’ Sustainable Development Goals mark aunique window of opportunity for both human and planetaryhealth. With rising life expectancy and rapidly expanding urbanpopulations exposed to pollution and sedentary lifestyles, thereis a greater focus on reducing the gap between life...... expectancyand number of healthy years lived, whilst limiting anthropogenicactivities contributing to pollution and climate change. Thus,urban development and policies, which can create win–winsituations for our planet and human health, falls into the realmand expertise of public health. However, some...
Wenger, A F
Decisions about health promotion and illness prevention occur within a cultural context that is influenced by the contemporary context of community and family in addition to the ethnohistorical and language contexts, worldview and sociocultural factors of the particular culture and the available folk and professional health care resources. Using information about the health and care beliefs and values and health care decision making process in negotiating culturally congruent nursing and health care interventions is imperative, especially in a world with limited health care resources and an increasing demand for recognition of cultural diversity. This article uses data on health and health care decision-making from an ethnonursing study of the Old Order Amish to demonstrate the role of cultural context in health care practices and decision making. Leininger's cultural care theory and Hall's conceptualization of high context culture were used to investigate these phenomena. High context features of the Old Order Amish culture are used to explain how Amish are actively involved in decisions and actions taken to promote health and prevent and treat illness using a broad array of folk, alternative and professional services simultaneously. As nurses learn to involve clients in decisions and actions using the guiding principles of cultural care preservation, accommodation and repatterning they will provide culturally congruent care for Amish and other culture-specific groups.
Paulo M. Buss
Full Text Available ABSTRACT This article analyzes the dynamic interaction between the Health in All Policies (HiAP agenda and the ongoing implementation of the 2030 Agenda for Sustainable Development. At the World Conference on Social Determinants of Health, held in Rio de Janeiro in October 2011, the Rio Political Declaration pledged to use HiAP as a mechanism to address health inequities. In 2014, the Ministers of Health of the Region of the Americas approved a regional Plan of Action of the Pan American Health Organization (PAHO that sought to call attention to the health consequences and benefits of policies and actions developed by other sectors. The HiAP approach seeks to integrate activities across the pillars of the sustainable development governance framework (economic, social, and environmental development. Advocates of the process are challenged to consider, using guiding questions outlined at the close of this article, how to pursue action at the country level and in what ways the HiAP approach can contribute to timely and effective implementation of the Sustainable Development Goals (SDGs. The authors propose that coordination between the 2030 Agenda and the regional Plan of Action on HiAP can make an important contribution to the implementation of both processes in the Region.
Derose, Kathryn Pitkin; Escarce, José J; Lurie, Nicole
Immigrants have been identified as a vulnerable population, but there is heterogeneity in the degree to which they are vulnerable to inadequate health care. Here we examine the factors that affect immigrants' vulnerability, including socioeconomic background; immigration status; limited English proficiency; federal, state, and local policies on access to publicly funded health care; residential location; and stigma and marginalization. We find that, overall, immigrants have lower rates of health insurance, use less health care, and receive lower quality of care than U.S.-born populations; however, there are differences among subgroups. We conclude with policy options for addressing immigrants' vulnerabilities.
... Series Urinary Tract Imaging Urodynamic Testing Virtual Colonoscopy Celiac Disease Testing (for Health Care Professionals) Serologic tests for celiac disease provide an effective first step in identifying candidates ...
Thorne, L M
Why are medical costs rising so rapidly? What are the factors involved that influence those costs? Does inflation affect health care costs? Can anything be done? The solutions to these complex issues are not clearly understood. It is clear, however, that the resolutions to these questions must be found quickly. If the causes of rising medical care costs are not promptly diagnosed and treated, we may find our economic health to be in critical condition. This paper attempts to better understand the reasons for increasing health care costs. The role that inflation plays relative to health care costs is investigated.
Pont, Jörg; Stöver, Heino; Wolff, Hans
Despite the dissemination of principles of medical ethics in prisons, formulated and advocated by numerous international organizations, health care professionals in prisons all over the world continue...
Jun, Gyuchan Thomas; Ward, James; Morris, Zoe; Clarkson, John
The role of process modelling has been widely recognized for effective quality improvement. However, application in health care is somewhat limited since the health care community lacks knowledge about a broad range of methods and their applicability to health care. Therefore, the objectives of this paper are to present a summary description of a limited number of distinct modelling methods and evaluate how health care workers perceive them. Various process modelling methods from several different disciplines were reviewed and characterized. Case studies in three different health care scenarios were carried out to model those processes and evaluate how health care workers perceive the usability and utility of the process models. Eight distinct modelling methods were identified and characterized by what the modelling elements in each explicitly represents. Flowcharts, which had been most extensively used by the participants, were most favoured in terms of their usability and utility. However, some alternative methods, although having been used by a much smaller number of participants, were considered to be helpful, specifically in understanding certain aspects of complex processes, e.g. communication diagrams for understanding interactions, swim lane activity diagrams for roles and responsibilities and state transition diagrams for a patient-centred perspective. We believe that it is important to make the various process modelling methods more easily accessible to health care by providing clear guidelines or computer-based tool support for health care-specific process modelling. These supports can assist health care workers to apply initially unfamiliar, but eventually more effective modelling methods.
Full Text Available While some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centres. Our study objectives were to: (a describe the scope and quality of health promotion activities; (b describe the status of health centre system support for health promotion activities; and (c introduce a CQI intervention and examine the impact on health promotion activities and health centres systems over two years. Baseline assessments showed sub-optimal health centre systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health centre systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence based health promotion by engaging front line health practitioners in decision making processes about the design/redesign of health centre systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff and members of the local community to address organisational and policy level barriers.
Jarvis, W R
In the past, health care was delivered mainly in acute-care facilities. Today, health care is delivered in hospital, outpatient, transitional care, long-term care, rehabilitative care, home, and private office settings. Measures to reduce health-care costs include decreasing the number of hospitals and the length of patient stays, increasing outpatient and home care, and increasing long-term care for the elderly. The home-care industry and managed care have become major providers of health ca...
Full Text Available Abstract Background Rural communities throughout Australia are experiencing demographic ageing, increasing burden of chronic diseases, and de-population. Many are struggling to maintain viable health care services due to lack of infrastructure and workforce shortages. Hence, they face significant health disadvantages compared with urban regions. Primary health care yields the best health outcomes in situations characterised by limited resources. However, few rigorous longitudinal evaluations have been conducted to systematise them; assess their transferability; or assess sustainability amidst dynamic health policy environments. This paper describes the study protocol of a comprehensive longitudinal evaluation of a successful primary health care service in a small rural Australian community to assess its performance, sustainability, and responsiveness to changing community needs and health system requirements. Methods/Design The evaluation framework aims to examine the health service over a six-year period in terms of: (a Structural domains (health service performance; sustainability; and quality of care; (b Process domains (health service utilisation and satisfaction; and (c Outcome domains (health behaviours, health outcomes and community viability. Significant international research guided the development of unambiguous reliable indicators for each domain that can be routinely and unobtrusively collected. Data are to be collected and analysed for trends from a range of sources: audits, community surveys, interviews and focus group discussions. Discussion This iterative evaluation framework and methodology aims to ensure the ongoing monitoring of service activity and health outcomes that allows researchers, providers and administrators to assess the extent to which health service objectives are met; the factors that helped or hindered achievements; what worked or did not work well and why; what aspects of the service could be improved and how
Akachi, Yoko; Kruk, Margaret E
The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.
Chen, Ping-Jen; Liang, Fu-Wen; Ho, Chung-Han; Cheng, Shao-Yi; Chen, Yi-Chen; Chen, Yu-Han; Chen, Yueh-Chun
The association between palliative care and life-sustaining treatments for patients with dementia is unclear in Asian countries. To analyse the use of palliative care and its association with aggressive treatments based on Taiwanese national data. A matched cohort study was conducted. The association between intervention and outcome was evaluated using conditional logistic regression analyses. The source population comprised 239,633 patients with dementia diagnosed between 2002 and 2013. We selected patients who received palliative care between 2009 and 2013 (the treatment cohort; N = 1996) and assembled a comparative cohort ( N = 3992) through 1:2 matching for confounding factors. After 2009, palliative care was provided to 3928 (1.64%) patients of the dementia population. The odds ratio for undergoing life-sustaining treatments in the treatment cohort versus the comparative cohort was 1 for some treatments (e.g. 1.73 for tube feeding (95% confidence interval: 1.54-1.95)). Palliative care was more consistently associated with fewer life-sustaining treatments for those with cancer. Palliative care is related to reduced life-sustaining treatments for patients with dementia. However, except in the case of tube feeding, which tended to be provided alongside palliative care regardless of cancer status, having cancer possibly had itself a protective effect against the use of life-sustaining treatments. Modifying the eligibility criteria for palliative care in dementia, improving awareness on the terminal nature of dementia and facilitating advance planning for dementia patients may be priorities for health policies.
Johnston, Rosemary; DelConte, Beth A; Ungvary, Libby; Fiene, Richard; Aronson, Susan S
Many families enroll their infants and toddlers in early education and child care programs. The Pennsylvania Chapter of the American Academy of Pediatrics recruited 32 child care centers that care for infants and toddlers to be linked with a child care health consultant (CCHC). Project staff assigned the centers alternately to an immediate intervention or a 1-year delayed intervention (contrast) group. At entry into the project, and then 1 and 2 years later, an evaluator assessed center compliance with 13 standards for infants and toddler care selected from Caring for Our Children: National Health and Safety Performance Standards (3rd ed.). Project staff linked the Immediate Intervention centers with a CCHC in Year 1. In Year 2, in a crossover comparison, project staff linked Contrast centers with a CCHC. Working with a CCHC effectively improved compliance with some selected health and safety standards. Copyright © 2017 National Association of Pediatric Nurse Practitioners. All rights reserved.
Provost, Shannon M; Lanham, Holly J; Leykum, Luci K; McDaniel, Reuben R; Pugh, Jacqueline
Health care huddles are increasingly employed in a range of formats but theoretical mechanisms underlying huddles remain relatively uncharted. A complexity science view implies that essential managerial strategies for high-performing health care organizations include meaningful conversations, enhanced relationships, and a learning culture. These three dimensions informed our approach to studying huddles. We explore new theories for how and why huddles have been useful in health care organizations. We used a study design incorporating literature review, direct observation, and semistructured interviews. A complexity science framework guided data collection in three health care settings; we also incorporated theories on high-reliability organizations to analyze our observations and interpret huddle participants' perspectives. We identify theoretical paths that could link huddles to improvement in patient safety outcomes. Huddles create time and space for conversations, enhance relationships, and strengthen a culture of safety. Huddles can be of particular value to health care organizations seeking or sustaining high reliability. Achieving high reliability, the organizational capacity to deliver what is intended to be delivered every time is difficult in complex systems. Managers have potential to create conditions from which huddle outcomes that support high reliability are more likely to emerge. Huddles support efforts to improve patient safety when they afford opportunities for heedful interactions to take place among individuals caring for patients and embed mindfulness into the organization.
Full Text Available O estudo analisa a sustentabilidade da Política Nacional de Avaliação da Atenção Básica a partir da identificação e categorização dos eventos críticos representativos do processo de institucionalização. Pesquisa avaliativa com duas unidades de análise: Gestão Federal da Atenção Básica e Secretarias Estaduais de Saúde (SES. Estudo de casos múltiplos com dados coletados por meio de entrevistas e documentos institucionais, usando a técnica de Incidentes Críticos. Os eventos classificados temporalmente como específicos da implantação, da sustentabilidade e mistos, foram categorizados analiticamente como de memória, adaptação, valores e regras. A Gestão Federal e uma das SES resultaram no nível médio de sustentabilidade, a outra SES foi classificada no nível forte. Os resultados indicam concomitância dos eventos e sugerem uma ponderação, pois os de adaptação das atividades, adequação e estabilização dos recursos demonstraram forte influência sobre os outros. Inovações e Desenvolvimento da Capacidade Técnica são considerados os resultados mais importantes no sentido da sustentabilidade.This study analyzes the sustainability of Brazil's National Policy for the Evaluation of Primary Health Care, based on the identification and categorization of representative critical events in the institutionalization process. This was an evaluative study of two analytical units: Federal Management of Primary Health Care and State Health Secretariats, using multiple case studies with data collected through interviews and institutional documents, using the critical incidents technique. Events that were temporally classified as specific to implementation, sustainability, and mixed were categorized analytically as pertaining to memory, adaptation, values, and rules. Federal management and one of the State Health Secretariats showed medium-level sustainability, while the other State Secretariat showed strong sustainability. The
Reddy, K Srinath; Mathur, Manu Raj; Negi, Sagri; Krishna, Bhargav
Adoption of the Sustainable Development Goals (SDGs) by member states of the United Nations (UN) has set a new agenda for public health action at national and global levels. The changed context calls for a reframing of what constitutes effective leadership in public health, through a construct that reflects the interdependence of leadership at multiple levels across the health system and its partners in other sectors. This is especially important in the context of Low and Middle Income Countries (LMICs) that are facing complex demographic and epidemiological transitions. The health system needs to exercise leadership that effectively mobilises all its resources for maximising health impact, and channels trans-disciplinary learning into well-coordinated multi-sectoral action on the wider determinants of health. Leadership is essential not only at the level of inspirational individuals who can create collective vision and commitment but also at the level of supportive institutions situated in or aligned to the health system. In turn, the health system as a whole has to exercise leadership that advances public health in the framework of sustainable development. This commentary examines the desirable attributes of effective leadership at each of these levels and explores the nature of their inter-dependence. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: email@example.com.
Liu, Y; Hsiao, W C; Eggleston, K
This paper examines the changes in equality of health and health care in China during its transition from a command economy to market economy. Data from three national surveys in 1985, 1986, and 1993 are combined with complementary studies and analysis of major underlying economic and health care factors to compare changes in health status of urban and rural Chinese during the period of economic transition. Empirical evidence suggests a widening gap in health status between urban and rural residents in the transitional period, correlated with increasing gaps in income and health care utilization. These trends are associated with changes in health care financing and organization, including dramatic reduction of insurance cover for the rural population and relaxed public health. The Chinese experience demonstrates that health development does not automatically follow economic growth. China moves toward the 21st century with increasing inequality plaguing the health component of its social safety net system.
Esma Kabasakal; Gülümser Kublay
Preventable diseases pose a serious problem worldwide. The role of primary healthcare professionals is especially significant in promoting health. Aim: It is aimed to determine the health care professionals working in family health centres have on health education and health promotion skills. Method: The study sample included 144 health care professionals employed in one of 33 family health centres in Ankara Province. The study data were collected using a survey developed on the h...
nutrition, attendance of antenatal care, immunisation and discouraging behaviours such as excessive alcohol consumption.5,6,7 In addition this encourages the maximum utilization of the few available health workers thereby improving accessibility. Integrating mental health into primary health care –. Uganda's experience.
Alana Tamar Oliveira de Sousa; Solange Fátima Geraldo da Costa; Patrícia Serpa de Souza Batista; Jael Rúbia Figuêiredo de Sá França; João Paulo de Figuêiredo Sá
The Health Community Agent (HCA) has contributed in a meaningful way to enhance the bond professional-user/family, providing, thus, the humanized care for the users who receive attention from the Family Health Strategy (FHS...
Alana Tamar Oliveira de Sousa; Solange Fátima Geraldo da Costa; Patrícia Serpa de Souza Batista; Jael Rúbia Figuêiredo de Sá França; João Paulo de Figuêiredo Sá
The Health Community Agent (HCA) has contributed in a meaningful way to enhance the bond professional-user/family, providing, thus, the humanized care for the users who receive attention from the Family Health Strategy (FHS...
... Enter ZIP code here Health Awareness Campaigns: Sexual Trauma Sexual Trauma Women Veterans Health Care has created materials to ... 10-320LG Dimensions: 11" x 17" Effects of Sexual Trauma One in five women in the United States ...
... for the Obesity Epidemic KENNETH E. WARNER 99 8 Patterns and Causes of Disparities in Health DAVID R. WILLIAMS 115 9 Addressing Racial Inequality in Health Care SARA ROSENBAUM AND JOEL TEITELBAU...
Zlotnik, Sarah; Wilson, Leigh; Scribano, Philip; Wood, Joanne N; Noonan, Kathleen
Improving the health of children in foster care requires close collaboration between pediatrics and the child welfare system. Propelled by recent health care and child welfare policy reforms, there is a strong foundation for more accountable, collaborative models of care. Over the last 2 decades health care reforms have driven greater accountability in outcomes, access to care, and integrated services for children in foster care. Concurrently, changes in child welfare legislation have expanded the responsibility of child welfare agencies in ensuring child health. Bolstered by federal legislation, numerous jurisdictions are developing innovative cross-system workforce and payment strategies to improve health care delivery and health care outcomes for children in foster care, including: (1) hiring child welfare medical directors, (2) embedding nurses in child welfare agencies, (3) establishing specialized health care clinics, and (4) developing tailored child welfare managed care organizations. As pediatricians engage in cross-system efforts, they should keep in mind the following common elements to enhance their impact: embed staff with health expertise within child welfare settings, identify long-term sustainable funding mechanisms, and implement models for effective information sharing. Now is an opportune time for pediatricians to help strengthen health care provision for children involved with child welfare. Copyright © 2015. Published by Elsevier Inc.
O'Loughlin, J; Renaud, L; Richard, L; Gomez, L S; Paradis, G
This study investigated factors related to the perceived sustainability of 189 heart health promotion interventions initiated by a public health department or research initiative and implemented in a variety of organizations across Canada. Data were collected in a telephone survey of key informants from schools, restaurants, grocery stores, health care facilities, and sports facilities that had implemented a heart health promotion intervention (risk factor screening, courses for smoking cessation, healthy eating or physical activity, support groups to promote healthy lifestyles, environmental modification, dissemination of information) in the past 8 years. Overall, 43.6% of 189 interventions were perceived to be very permanent, 34.8% were somewhat permanent, and 21.5% were not permanent. Independent correlates of perceived sustainability included intervention used no paid staff (odds ratio (OR) 95% confidence interval (95% Cl) = 3.7 (1.8, 7.5)), intervention was modified during implementation (OR (95% Cl) = 2.7 (1.4, 5.0)), there was a good fit between the local provider and the intervention (OR (95% Cl) = 2.4 (1.2, 5.0)), and there was the presence of a program champion (OR (95% Cl) = 2.3 (1.2, 4.4)). Consideration of these factors by health promotion program planners could increase the potential for sustainability of health promotion interventions implemented in the community. Copyright 1998 American Health Foundation and Academic Press.
Vermeer, A J M; Van Assema, P; Hesdahl, B; Harting, J; De Vries, N K
We assessed the perceived sustainability of community health programs organized by local intersectoral coalitions, as well as the factors that collaborating partners think might influence sustainability. Semi-structured interviews were conducted among 31 collaborating partners of 5 community health programs in deprived neighborhoods in the southern part of the Netherlands. The interview guide was based on a conceptual framework that includes factors related to the context, the leading organization, leadership, the coalition, collaborating partners, interventions and outcomes. Interviews were recorded, transcribed and content analyzed using NVivo 8.0. Participants in each of the programs varied in their perceptions of the sustainability of the program, but those people collaborating in pre-existing neighborhood structures expressed relatively high faith in their continuation. The participating citizens in particular believed that these structures would continue to address the health of the community in the future. We found factors from all categories of the conceptual framework that were perceived to influence sustainability. The program leaders appeared to be crucial to the programs, as they were frequently mentioned in close interaction with other factors. Program leaders should use a motivating and supportive leadership style and should act as 'program champions'. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Wisener, Katherine; Shapka, Jennifer; Jarvis-Selinger, Sandra
Despite evidence supporting the ongoing provision of health education interventions in First Nations communities, there is a paucity of research that specifically addresses how these programs should be designed to ensure sustainability and long-term effects. Using a Community-Based Research approach, a collective case study was completed with three Canadian First Nations communities to address the following research question: What factors are related to sustainable health education programs, and how do they contribute to and/or inhibit program success in an Aboriginal context? Semi-structured interviews and a sharing circle were completed with 19 participants, including members of community leadership, external partners, and program staff and users. Seven factors were identified to either promote or inhibit program sustainability, including: 1) community uptake; 2) environmental factors; 3) stakeholder awareness and support; 4) presence of a champion; 5) availability of funding; 6) fit and flexibility; and 7) capacity and capacity building. Each factor is provided with a working definition, influential moderators, and key evaluation questions. This study is grounded in, and builds on existing research, and can be used by First Nations communities and universities to support effective sustainability planning for community-based health education interventions.
Rice, J A; Isakova, L; Zelckovich, R; Frid, E
Integrated health care systems: a concept being discussed throughout Russia and the world. A concept with three different applications and a confusing interaction with the concept of "capitation payments." The health reform debate in Russia and the NIS can only advance if greater clarity is found for these concepts, and if medical leaders are prepared for the substantial changes in provider behavior that are required with integrated health care systems fueled by capitation payments. This article explores the twin concepts of capitation and integrated health care systems, and then the leadership challenges for Russian health sector managers as they prepare for these challenges of the twenty-first century.
Alana Tamar Oliveira de Sousa; Solange Fátima Geraldo da Costa; Patrícia Serpa de Souza Batista; Jael Rúbia Figuêiredo de Sá França; João Paulo de Figuêiredo Sá
The Health Community Agent (HCA) has contributed in a meaningful way to enhance the bond professional-user/family, providing, thus, the humanized care for the users who receive attention from the Family Health Strategy (FHS). This research had the aim to investigate the strategies adopted by the health community agents in order to supply the humanized care for the FHS user. It is an exploratory research of qualitative nature which was accomplished in the Basic Health Units –...
Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica
The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670
Andrianarisoa, A O; Rampanjato, M
In 1976, Madagascar promised to establish 1500 primary health care centers to be run by a community health agent. The communities selected sites for the centers, nominated health agent candidates, built and maintained the centers and accommodation for the health agents, supplied the centers, and undertook their operation. The government organized the recruitment and training of the agents, paid their wages, and provided equipment and drugs. The candidates were 18-28 years old and had completed two years of secondary education. Training lasted 14 months and enabled the new agents to provide basic health care in the curative, preventive, and educational fields. The health agents can deal with normal births, family planning, vaccination, and health education. In 1991 the country had 1935 facilities that were providing primary care. Some 85% of the health agents have remained in the primary health care centers for over 10 years; 50 agents have moved out to become nurses or midwives. Financial support for the program comes from the state and external donors. Of the 1500 planned primary health care centers, 461 stopped functioning, mostly because the communities concerned have not adequately built and maintained premises for the health agents. The primary health care centers are less frequently attended than formerly because equipment is aging and drugs are in short supply. Cost recovery should be widely adopted in the national health system. More in-service training should be provided for health agents, and more tours of inspection should be carried out. Community health workers should be managed entirely by the community, and the Ministry of Health should take charge of their training. Primary health care in Madagascar has largely proved its worth; if the economic handicaps can be overcome, the program is likely to contribute to the achievement of the health-for-all goals.
Ellner, Andrew L; Stout, Somava; Sullivan, Erin E; Griffiths, Elizabeth P; Mountjoy, Ashlin; Phillips, Russell S
Challenged by demands to reduce costs and improve service delivery, the U.S. health care system requires transformational change. Health systems innovation is defined broadly as novel ideas, products, services, and processes-including new ways to promote healthy behaviors and better integrate health services with public health and other social services-which achieve better health outcomes and/or patient experience at equal or lower cost. Academic health centers (AHCs) have an opportunity to focus their considerable influence and expertise on health systems innovation to create new approaches to service delivery and to nurture leaders of transformation. AHCs have traditionally used their promotions criteria to signal their values; creating a health systems innovator promotion track could be a critical step towards creating opportunities for innovators in academic medicine. In this Perspective, the authors review publicly available promotions materials at top-ranked medical schools and find that while criteria for advancement increasingly recognize systems innovation, there is a lack of specificity on metrics beyond the traditional yardstick of peer-reviewed publications. In addition to new promotions pathways and alternative evidence for the impact of scholarship, other approaches to fostering health systems innovation at AHCs include more robust funding for career development in health systems innovation, new curricula to enable trainees to develop skills in health systems innovation, and new ways for innovators to disseminate their work. AHCs that foster health systems innovation could meet a critical need to contribute both to the sustainability of our health care system and to AHCs' continued leadership role within it.
Dulal, R K
Nepal has entered from its unitary system into a new "Federal Democratic Republic State". The current constitution presents basic health care services as a fundamental right. The Ministry for Health and Population has been providing resources to meet health demands, but managers are wrestling to meet these demands. Persistent disparities between rural and urban and across regions resulted inferior health outcomes, e.g., life expectancy in an urban district like Bhaktapur is 71 years, whereas in the rural district of Mugu it is 44 years. The poor health and poor access to health care in the past systems prompted people to seek a different model. Ultimately, all political parties except one have agreed on federalism. The exact number of federal states that are going to be created is unknown. In federalism, all federated states have to assume certain relationships between the locality, the region, and the nation that apply not only in politics but in health care too. Managing changes in health care organization during the transitional period and after restructuring the unitary Nepal into federal states should be carefully planned. In case, if new system also fails to deliver necessary health care services, the possibility of igniting of dissatisfaction, public unrest and even disintegration cannot be ignored. In order to outline a structure and give life to a health care system under federalism, health care professionals need to engage themselves seriously.
The purpose of this article is to examine to what extent the Sustainable Development Goals (SDGs) hold out new promises for health in Africa. Two significant shortcomings will have to be overcome. Application of a 'social determinants of health' approach is still woefully difficult in Africa due to the stronghold that international actors maintain over local governments. The persistence of a 'turnkey' concept of health policies is reflected in the coexistence of a disparate range of programmes and measures, often driven by the development partners. Thus the low level of institutional complementarities is a crucial issue in the effective implementation of the SDGs.
Combined Logistics Captains Career Course and is currently attending Intermediate Level Education. Figure 1. This table is an example of a targeting...Fort Polk, Louisi- ana, where two trends emerged: most sustainers did not understand how to participate in the targeting process, and sustainers do...not always clearly understand their relevance to target- ing working groups. Both trends oc- curred because sustainers do not know how the targeting
This reduction was not achieved through the use of sophisticated care such as bone marrow transplant, but through the adoption of a Comprehensive Health Care Management protocol for sickle cell disease. This protocol of care emphasizes prevention of crises through effective management of the disease. In Africa, where ...
Cordera, A; Bobenrieth, M
This paper describes the basic educational planning process involved in primary health care programs in developing countries. The problem in present educational programs are the lack of concentration by educators on the distribution of resources and the lack of achieving objectives of specific services. Educational planning seeks to ascertain the existing situation in a defined social setting in order to develop educational programs consistent with general development efforts. General learning and motivation principles include meaningfulness, requirements, modeling, open communication, freshness, active practice, adequate distribution of practical work, phasing out assistance, and developing agreeable conditions for learning. The purpose of an educational program should be "product-oriented" or "impact-oriented." Educational objectives can be reached through a process of elements in a cognitive, affective, or psycomotor domain. The curriculum process includes the following 5 stages: 1) selection of purpose and objectives, 2) organization of learning experiences, 3) selection of program content material), 4) selection of teaching methods, and 5) evaluation of the effectiveness of stages 2-4.
Payne, Julianne; Razi, Sima; Emery, Kyle; Quattrone, Westleigh; Tardif-Douglin, Miriam
Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.
Borba, C P C; Gelaye, B; Zayas, L; Ulloa, M; Lavelle, J; Mollica, R F; Henderson, D C
Our program attempted to improve attitudes and confidence of Peruvian primary care physicians (PCPs) providing mental health care. The training program underwent an evaluation to determine impact of sustained confidence in performing medical and psychiatric procedures, and application of learned skills. Fifty-two Peruvian primary care practitioners were trained at the Harvard Program in Refugee Trauma (HPRT) over a two-week period. There was significant improvement in PCPs' confidence levels of performing psychiatric procedures (counseling, prescribing medications, psychiatric diagnosis, assessing the risk for violence, and treating trauma victims) when comparing baseline and post-two-week to one year follow-up. When comparing post-two-week and one-year follow-up quantitative measures, confidences levels went slightly down. This may be an implication that the frequency of trainings and supervisions are needed more frequently. In contrast, qualitative responses from the one-year follow-up revealed increase in victims of violence clinical care, advocacy, awareness, education, training, policy changes, accessibility of care, and sustainment of diagnostic tools. This study supports the feasibility of training PCP's in a culturally effective manner with sustainability over time.
Brink-Muinen, A. van den; Bensing, J.M.; Kerssens, J.J.
Objectives: differences were investigated between general practitioners providing women's health care (4 women) and general practitioners providing regular health care (8 women and 8 men). Expectations were formulated on the basis of the principles of women's health care and literature about gender
Flanagan, Elaine; Chopra, Teena; Mody, Lona
With the changing health care delivery, patients receive care at various settings, including acute care hospitals, skilled nursing facilities (SNFs), and ambulatory clinics, thus becoming exposed to pathogens. Various health care settings face unique challenges requiring individualized infection control programs. The programs in SNFs should address surveillance for infections and antimicrobial resistance, outbreak investigation and control plan for epidemics, isolation precautions, hand hygiene, staff education, and employee and resident health programs. In ambulatory clinics, the program should address triage and standard transmission-based precautions; cleaning, disinfection, and sterilization principles; surveillance in surgical clinics; safe injection practices; and bioterrorism and disaster planning. Published by Elsevier Inc.
Andersen, Kim Normann; Agger Nielsen, Jeppe; Kim, Soonhee
This paper brings forward five propositions on the use of online communication in health care, its potential impacts on efficiency and effectiveness in health care, and which role government should play in moving forward the use of online communication. In the paper, each of the five propositions...
Josyula, Lakshmi; Lyle, Roseann
Purpose: To examine the feasibility and impact of a health care provider’s (HCP) physical activity (PA) prescription on the PA of patients on preventive care visits. Methods: Consenting adult patients completed health and PA questionnaires and were sequentially assigned to intervention groups. HCPs prescribed PA using a written prescription only…
The Social Protection Model in Latin America. 3. After a Decade of Reforms in Latin America. 7. Some Issues in Comparative Analysis. 12. Methodological Options. 20. Section II. Analysis of Health Care Policies. Chapter 2. The Context and Process of Health Care. Reform in Argentina — Susana Belmartino. 27. Introduction.
Westert, G.P.; Berg, M.J. van den; Koolman, X.; Verkleij, H.
This is the second national report on the performance of the Dutch health care system. Its focus is on quality, access and costs in 2006/7. The Dutch Health Care Performance Report presents a broad picture based on 110 indicators. Where possible, comparisons in time and between countries are
Conclusions: This study has served to investigate the general skills of health care professionals in regard to patient safety. It provides new knowledge about the topic in the context of the Baltic countries and can thus be used in the future development of health care services.
Klecun, Ela; Lichtner, Valentina; Cornford, Tony
This paper explores notions of e-Literacy (otherwise IT literacy or digital literacy) in health care. It proposes a multi-dimensional definition of e-Literacy in health care and provides suggestions for policy makers and managers as to how e-Literacy might be accounted for in their decisions.
E.K.A. van Doorslaer (Eddy); O.A. O'Donnell (Owen); R.P. Rannan-Eliya (Ravi); A. Somanathan (Aparnaa); S.R. Adhikari (Shiva Raj); C.C. Garg (Charu); D. Harbianto (Deni); A.N. Herrin (Alejandro); M.N. Huq (Mohammed); S. Ibragimova (Shamsia); A. Karan (Anup); T-J. Lee (Tae-Jin); G.M. Leung (Gabriel); J-F.R. Lu (Jui-fen Rachel); C.W. Ng (Ng); B.R. Pande (Badri Raj); R. Racelis (Rachel); S. Tao (Tao); K. Tin (Keith); K. Tisayaticom (Kanjana); L. Trisnantoro (Laksono); C. Vasavid (Vasavid); Y. Zhao (Yuxin)
textabstractOut-of-pocket (OOP) payments are the principal means of financing health care throughout much of Asia. We estimate the magnitude and distribution of OOP payments for health care in fourteen countries and territories accounting for 81% of the Asian population. We focus on payments that
Roemeling, Oskar; Land, Martin; Ahaus, C
Purpose - The purpose of this paper is to investigate the roles that employee-initiated Lean improvement projects play in health care. Lean ideas are introduced to improve flow in health care. Although variability is detrimental to flow performance, it is unclear whether Lean initiatives set out to
Leininger, Lindsey; Levy, Helen
It might seem strange to ask whether increasing access to medical care can improve children's health. Yet Lindsey Leininger and Helen Levy begin by pointing out that access to care plays a smaller role than we might think, and that many other factors, such as those discussed elsewhere in this issue, strongly influence children's health.…
Van Bewer, Vanessa
To analyze the concept of transdisciplinarity and provide an enhanced definition of transdisciplinarity in health care. The term transdisciplinarity is increasingly prevalent in health care research and has been identified as important to improving the effectiveness and efficiency in health care. However, the term continues to be misappropriated and poorly understood by researchers and clinicians alike which hinders its potential use and impact. Walker and Avant's (2005) method of concept analysis was used as a framework for the study of the concept. The databases PubMed, CINAHL, Academic Search Premier, PsycInfo and ERIC were used searching the terms transdisciplinarity, transdisciplinary, interdisciplinary and interdisciplinarity. Transdisciplinarity in health care involves transcending of disciplinary boundaries, a sharing of knowledge, skills and decision-making, a focus on real-world problems and the inclusion of multiple stakeholders including patients, their families and their communities. An enhanced definition of transdisciplinarity in health care emerged from this concept analysis that may provide clarity and direction for health care providers. Nurses, and other health care providers, can look to this definition to understand transdisciplinary health care teams as opposed to multidisciplinary, and interdisciplinary ones. © 2017 Wiley Periodicals, Inc.
The purpose of this paper is to explore challenges to the performance and sustainability of mutual health organisations (MHOs) and health institutions towards enhancing access to quality health care (HC) in Ghana. Data were gathered through interviews and documentary review. Problems with late release of reimbursement funds for discharging with claims by the central government has impacted heavily on the financial and strategic management and decision-making processes of the MHOs and health institutions. The lack of in-depth analysis of the financial viability of the MHOs; and the limited number of schemes selected. Recommends the need to ensure prompt release of reimbursement funds by government to enable the MHOs to reimburse claims to health institutions. There is a perceived tension between the MHOs and HC institutions due to late release of reimbursement funds by the government. Contributes to understanding of how the NHI Act influences the operations of MHOs and health institutions towards increasing access to quality HC and financing.
Mate, Kedar S; Salinas, Gilbert
There is considerable interest in ideas borrowed from education about "flipping the classroom" and how they might be applied to "flipping" aspects of health care to reach the Triple Aim of improved health outcomes, improved experience of care, and reduced costs. There are few real-life case studies of "flipping health care" in practice at the individual patient level. This article describes the experience of one of the authors as he experienced having to "flip" his primary health care. We describe seven inverted practices in his care, report outcomes of this experiment, describe the enabling factors, and derive lessons for patient-centered primary care redesign. Copyright © 2014 Elsevier Inc. All rights reserved.
Karuppan, Corinne M; Karuppan, Muthu
Despite much coverage in the popular press, only anecdotal evidence is available on medical tourists. At first sight, they seemed confined to small and narrowly defined consumer segments: individuals seeking bargains in cosmetic surgery or uninsured and financially distressed individuals in desperate need of medical care. The study reported in this article is the first empirical investigation of the medical tourism consumer market. It provides the demographic profile, motivations, and value perceptions of health care consumers who traveled abroad specifically to receive medical care. The findings suggest a much broader market of educated and savvy health care consumers than previously thought. In the backdrop of the health care reform, the article concludes with implications for health care providers.
In light of the ongoing debate about health care policy in the United States, including efforts to repeal and replace the Affordable Care Act, it will be critically important for the academic community to engage in the dialogue. Developing a viable approach to health care reform requires an understanding of the interaction and interdependence between choice, cost, and coverage in a competitive and functional market-based system. Some institutions have implemented models that indicate the feasibility of providing high-quality, efficient patient care while working within fixed budgets. The academic community must stay engaged in these conversations because of its moral commitment to equitable access to health care for all. Academic medical centers will also have to define and protect their roles in an evolving health care delivery system in the United States.
Simpser, Edwin; Hudak, Mark L
Pediatric home health care is an effective and holistic venue of treatment of children with medical complexity or developmental disabilities who otherwise may experience frequent and/or prolonged hospitalizations or who may enter chronic institutional care. Demand for pediatric home health care is increasing while the provider base is eroding, primarily because of inadequate payment or restrictions on benefits. As a result, home care responsibilities assumed by family caregivers have increased and imposed financial, physical, and psychological burdens on the family. The Patient Protection and Affordable Care Act set forth 10 mandated essential health benefits. Home care should be considered as an integral component of the habilitative and rehabilitative services and devices benefit, even though it is not explicitly recognized as a specific category of service. Pediatric-specific home health care services should be defined clearly as components of pediatric services, the 10th essential benefit, and recognized by all payers. Payments for home health care services should be sufficient to maintain an adequate provider work force with the pediatric-specific expertise and skills to care for children with medical complexity or developmental disability. Furthermore, coordination of care among various providers and the necessary direct patient care from which these care coordination plans are developed should be required and enabled by adequate payment. The American Academy of Pediatrics advocates for high-quality care by calling for development of pediatric-specific home health regulations and the licensure and certification of pediatric home health providers. Copyright © 2017 by the American Academy of Pediatrics.
Pushpangadan, M.; Burns, E.
Many frail or disabled elderly people are now being maintained in the community, partially at least as a consequence of the Community Care Act 1993. This paper details the work of the major health professionals who are involved in caring for older people in the community and describes how to access nursing, palliative care, continence, mental health, Hospital at Home, physiotherapy, occupational therapy, equipment, and optical, dental, and dietetic services. In many areas, services are evolvi...
Wentzer, Helle; Bygholm, Ann
of theories on human-computer interaction and IT-mediated communication, different empirical studies of IT implementation in health care are analyzed. The outcome is an analytical discernment between different relations of communication and levels of interaction with IT in health care infrastructure....... These relations and levels are synthesized into a framework for identifying tensions and potential problems in the mediation of health care with the IT system. These problems are also known as unexpected adverse consequences, UACs, from IT implementation into clinical health care practices. Results: This paper...... develops a conceptual framework for addressing transformations of communication and workflow in health care as a result of implementing IT. Conclusion and discussion: The purpose of the conceptual framework is to support the attention to and continuous screening for errors and unintended consequences...
Bisantz, Ann M; Fairbanks, Rollin J
Cognitive Engineering for Better Health Care Systems, Ann M. Bisantz, Rollin J. Fairbanks, and Catherine M. BurnsThe Role of Cognitive Engineering in Improving Clinical Decision Support, Anne Miller and Laura MilitelloTeam Cognitive Work Analysis as an Approach for Understanding Teamwork in Health Care, Catherine M. BurnsCognitive Engineering Design of an Emergency Department Information System, Theresa K. Guarrera, Nicolette M. McGeorge, Lindsey N. Clark, David T. LaVergne, Zachary A. Hettinger, Rollin J. Fairbanks, and Ann M. BisantzDisplays for Health Care Teams: A Conceptual Framework and Design Methodology, Avi ParushInformation Modeling for Cognitive Work in a Health Care System, Priyadarshini R. PennathurSupport for ICU Clinician Cognitive Work through CSE, Christopher Nemeth, Shilo Anders, Jeffrey Brown, Anna Grome, Beth Crandall, and Jeremy PamplinMatching Cognitive Aids and the "Real Work" of Health Care in Support of Surgical Microsystem Teamwork, Sarah Henrickson Parker and Shawna J. PerryEngageme...
Wang, H A; Wang, Y Z; Wang, S
The personal computer and the Internet have provided many useful services to both health care professionals and the general public. However, security remains a key factor that could limit their further growth potential. We reviewed and assessed the potential use of the cryptographic technique to resolve security issues. We also analyzed services available in the current market environment and determined their viability in supporting health care applications. While the cryptographic application has a great potential in protecting security of health care information transmitted over the Internet, a nationwide security infrastructure is needed to support deployment of the technology. Although desirable, it could be cost prohibitive to build a national system to be dedicated for the health care purpose. A hybrid approach that involves the government's development of a dedicated security infrastructure for health care providers and the use of commercial off-the-shelf products and services by the general public offers the most cost-effective and viable approach.
Extreme heat events are on the rise, evidenced by the record breaking heat in the summer of 2016 in the US, increased heat-related death toll in south Asia, and projections from the Intergovernmental Panel on Climate Change. The impacts, responses and adaptation to extreme heat are inherently local or region in nature and require multisector engagement to manage current and future heat risks. Understanding the character of the information demand, who needs it, when and how it is needed, how it is used, and the remaining research questions, requires sustained engagement of multiple science and decision making communities. The construct of Integrated Information Systems provides the framework that sustains this dialogue, supports the production of useful information, and the translation of knowledge to action. The National Integrated Heat Health Information System (NIHHIS), a multi-agency collaboration, working at state, local and international levels, designed to facilitate an integrated approach to providing a suite of decision support services that reduce heat-related illness and death. NIHHIS sustains engagement across the public health, emergency management, disaster risk reduction, planning, housing, communication, climate, weather and other science communities. This presentation will highlight NIHHS sustained engagements in the Rio Grande Bravo region, other NIHHIS pilots, and international efforts building on the NIHHIS framework. NIHHIS, launched by the National Oceanic and Atmospheric Administration and the Centers for Disease Control and Prevention in 2015, now has over eight Federal partners and a burgeoning mix of pilots, projects and partners at state, local and international levels.
Shaw, Charles D; Braithwaite, Jeffrey; Moldovan, Max; Nicklin, Wendy; Grgic, Ileana; Fortune, Triona; Whittaker, Stuart
To describe global patterns among health-care accreditation organizations (AOs) and to identify determinants of sustainability and opportunities for improvement. Web-based questionnaire survey. Organizations offering accreditation services nationally or internationally to health-care provider institutions or networks at primary, secondary or tertiary level in 2010. s) External relationships, scope and activity public information. Forty-four AOs submitted data, compared with 33 in a survey 10 years earlier. Of the 30 AOs that reported survey activity in 2000 and 2010, 16 are still active and stable or growing. New and old programmes are increasingly linked to public funding and regulation. While the number of health-care AOs continues to grow, many fail to thrive. Successful organizations tend to complement mechanisms of regulation, health-care funding or governmental commitment to quality and health-care improvement that offer a supportive environment. Principal challenges include unstable business (e.g. limited market, low uptake) and unstable politics. Many organizations make only limited information available to patients and the public about standards, procedures or results.
... Orthopedic Health Joint Health and Care: Prevention, Symptoms, Diagnosis & Treatment Past Issues / Spring 2009 Table of Contents For ... may be used to help achieve an accurate diagnosis, including: ... joint for examination Treatment The only type of arthritis that can be ...
Andrade, Raquel Dully; Mello, Débora Falleiros; Silva, Marta Angélica Iossi; Ventura, Carla Aparecida Arena
This narrative literature review aimed to identify the publications about health law, in the ambit of child health care. The databases LILACS and MEDLINE were searched, between 2004 and 2009. Thirteen articles were analyzed, and three themes were identified: Emphasis on knowledge, abilities and attitudes for the development of competencies; Partnerships as an imperative; Health and Law: intersectorial relationship. The studies about the practice of health law are relevant to our reality, especially in primary health care, pointing out for the possibilities of its applicability in the role of the nurses acting in the family health strategy, with families and children.
Honekamp, Ivonne; Possenriede, Daniel
This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing.
Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L
Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. © The Author(s) 2014.
Sun, Yuelian; Gregersen, Hans; Yuan, Wei
China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources. PMID:28356772
Oleribe, Obinna Ositadimma; Crossey, Mary Margaret Elizabeth; Taylor-Robinson, Simon David
The world's governments failed to achieve the Health for All 2000 goals from the Alma Ata Declaration of 1978. Although a lot of milestones have been covered since 2000, the world's governing authorities are unlikely to achieve the current Millennium Development Goals (MDGs) which expire by the end of this year. The inability to achieve these goals may be linked to the multiplicity of health-related directives and fragmentation of health systems in many countries. However, with the proposed 17 sustainability development goals, health has only one universal aim: to ensure healthy lives and promote wellbeing for all at all ages. Accomplishing this will require a focus on health systems (system-thinking), commonization of services and full integration of services with total dismantling of vertical programs across the world.
This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
High rates of stress and burnout among nurses and other health care providers justify the exploration of innovative interventions designed to reduce stress and promote self-care among this population. A growing body of evidence supports the physical and psychosocial benefits of yoga and suggests the potential for yoga to support self-care and reduce stress among health care providers. This article describes the formation of an academic-practice collaboration to use yoga as a model for occupational health and wellness among nurses employed at a tax-supported urban health system. In addition, recommendations for program sustainability over time are discussed. Copyright 2013, SLACK Incorporated.
Macinko, James; Montenegro, Hernán; Nebot Adell, Carme; Etienne, Carissa
At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44. R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels.
An important aspect of allowing patients to take control of their health care is the introduction of new procedures for dealing with complaints. This article examines the concepts that underpin the new Department of Health regulations on complaints management and what they will mean for health and social care professionals. It also explains why these regulations focus on restorative justice rather than blame when adverse events occur.
Full Text Available This paper considers indications and obstacles for the development of primary mental health care practice in both developed and under-developed countries. Both are considered as this represents the South African reality. While a significant body of literature has documented the need for primary mental health care, the obstacles (especially in terms of the commodification of health to its fruition are seldom addressed.
Full Text Available There is an emerging consensus that caring and compassion are under threat in the frenetic environment of modern healthcare. Enabling and sustaining compassionate care requires not only a focus on the needs of the patient, but also on those of the care giver. As such, threats and exhortations to health professionals are likely to have limited and perverse effects and it is to the organisational and system arrangements which support staff that attention should shift. Any approach to supporting compassionate care may work for some services, for some patients and staff, some of the time. No single approach is likely to be a panacea. Unravelling the contexts within which different approaches are effectual will allow for more selective development of support systems and interventions.
Maffei, Roxana; Burciago, Daniel; Dunn, Kim
Regional health information organizations (RHIOs) have the potential to alleviate today's health care problems by granting providers access to a supported body of clinical information for all patients in a given region. While the promise of and enthusiasm for RHIOs is immense, the issue of their financial sustainability remains unclear. It has been said that the business model supporting a regional or national health information network is as essential, if not more essential, than the technology that makes it feasible. Currently, there is a clear lack of concrete business models implemented in RHIOs' projects. This article reports the results of a literature review of the current status of the adaptation and implementation of business models by RHIOs for successful financial sustainability. Based on the review, this article also attempts to evaluate the existing financial situation of RHIOs to determine and recommend the best models of economic sustainability. Significant findings include RHIOs' present financial environment, planning, and self-sustainability methods. Future studies will be needed as RHIOs continue to grow and move toward the implementation phase of their development.
Signorelli, Carlo; Odone, Anna; Gozzini, Armando; Petrelli, Fabio; Tirani, Marcello; Zangrandi, Antonello; Zoni, Roberta; Florindo, Nicola
The rejection of the Constitutional Law Bill No.1429-D in the December 2016 referendum, has stimulated a cause for reflection on current health legislation and the future prospects of the Italian National Health Service; also in the context of the recent approval of the new Essential Levels of care (LEA) and other relevant laws approved by the Parliament. This article analyzes possible future legislative and organizational scenarios with particular regard to issues related to National health system's sustainability.
Despite well-documented links between low health literacy, low rates of health insurance coverage, and poor health outcomes, there has been almost no research on the relationship between low health literacy and self-reported access to care. This study analyzed a large, nationally representative sample of community-dwelling adults ages 50 and older to estimate the relationship between low health literacy and self-reported difficulty obtaining care. We found that individuals with low health literacy were significantly more likely than individuals with adequate health literacy to delay or forego needed care or to report difficulty finding a provider, even after controlling for other factors including health insurance coverage, employment, race/ethnicity, poverty, and general cognitive function. They were also more likely to lack a usual source of care, although this result was only marginally significant after controlling for other factors. The results show that in addition to any obstacles that low health literacy creates within the context of the clinical encounter, low health literacy also reduces the probability that people get in the door of the health care system in a timely way. PMID:27043757
Health insurance, in addition to being a technique for controlling and managing health risks, helps in placing the insured in a position for accessing health care delivery ahead of an illness. This instrument, which has been well utilized in developed economies, is what the National Health Insurance Scheme (NHIS) in Nigeria ...
Hudson, Christopher G.; DeVito, Jo Anne
Reviews research pertinent to mental health services under health care reform proposals. Examines redistributional impact of inclusion of outpatient mental health benefits, optimal benefit packages, and findings that mental health services lower medical utilization costs. Argues that extending minimalist model of time-limited benefits to national…